{
  "hospital_name": "UCLA West Valley Medical Center",
  "last_updated_on": "2026-03-29",
  "as_of_date": "2026-01-01",
  "version": "3.0.0",
  "location_name": [
    "UCLA West Valley Medical Center"
  ],
  "hospital_address": [
    "7300 Medical Center Drive, West Hills, CA 91307"
  ],
  "license_information": {
    "license_number": "930000028|CA",
    "state": "CA"
  },
  "type_2_npi": [
    "1801653969"
  ],
  "attestation": {
    "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",
    "confirm_attestation": true,
    "attester_name": "Tammy Wallace"
  },
  "standard_charge_information": [{
  "description": " Injection, Alemtuzumab",
  "code_information": [
    {
      "code": "Q9979",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7733.41,
      "maximum": 7733.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7733.412757,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "\"Silver Nitrate Applicator 6\"\"\"",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "12165010001",
      "type": "NDC"
    },
    {
      "code": "12165010003",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 34.65,
      "maximum": 165.0,
      "gross_charge": 165.0,
      "discounted_cash": 90.75,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 68.805,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 51.15,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.65,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 115.5,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 165.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.65,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.658,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.456,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 102.465,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.75,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 156.75,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 156.75,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 165.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 164.175,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 165.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.515,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 54.12,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66.66,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.44,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 160.941,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 153.945,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 156.222,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 149.4735,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 165.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 146.124,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "1 em core session",
  "code_information": [
    {
      "code": "G9873",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.0,
      "maximum": 20.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "12-24hr sealed lead acid",
  "code_information": [
    {
      "code": "K0733",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.9,
      "maximum": 28.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "1ST HOSP IP/OBS HIGH 75",
  "code_information": [
    {
      "code": "99223",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 80.1,
      "maximum": 80.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.1,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "1ST HOSP IP/OBS MODERATE 55",
  "code_information": [
    {
      "code": "99222",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 73.2,
      "maximum": 73.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.2,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "1ST HOSP IP/OBS SF/LOW 40",
  "code_information": [
    {
      "code": "99221",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 34.3,
      "maximum": 34.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.3,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "1ST NF CARE HIGH MDM 50",
  "code_information": [
    {
      "code": "99306",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 72.1,
      "maximum": 72.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72.1,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "1ST NF CARE MODERATE MDM 35",
  "code_information": [
    {
      "code": "99305",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 46.9,
      "maximum": 46.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "1ST NF CARE SF/LOW MDM 25",
  "code_information": [
    {
      "code": "99304",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.8,
      "maximum": 37.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.8,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "1ST OPN IMPLT BAT MODULJ SYS",
  "code_information": [
    {
      "code": "64654",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 56651.13,
      "maximum": 57177.64,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57177.6353,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56651.1295,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56651.1295,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56651.1295,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "1ST PSYC COLLAB CARE MGMT",
  "code_information": [
    {
      "code": "99492",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 117.53,
      "maximum": 282.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 159.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 179.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 158.973,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.0732,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.8756,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 146.913125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 138.68599,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 141.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "1ST/SBSQ PSYC COLLAB CARE",
  "code_information": [
    {
      "code": "99494",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 57.88,
      "maximum": 57.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2 em core ms mo 10-12 no wl",
  "code_information": [
    {
      "code": "G9877",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.0,
      "maximum": 12.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2 em core ms mo 10-12 wl",
  "code_information": [
    {
      "code": "G9879",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 48.0,
      "maximum": 48.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2 em core ms mo 7-9 no wl",
  "code_information": [
    {
      "code": "G9876",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.0,
      "maximum": 12.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2 em core ms mo 7-9 wl",
  "code_information": [
    {
      "code": "G9878",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 48.0,
      "maximum": 48.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2 em ongoing ms mo 13-15 wl",
  "code_information": [
    {
      "code": "G9882",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 40.0,
      "maximum": 40.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2 em ongoing ms mo 16-18 wl",
  "code_information": [
    {
      "code": "G9883",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 40.0,
      "maximum": 40.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2 em ongoing ms mo 19-21 wl",
  "code_information": [
    {
      "code": "G9884",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 40.0,
      "maximum": 40.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2 em ongoing ms mo 22-24 wl",
  "code_information": [
    {
      "code": "G9885",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 40.0,
      "maximum": 40.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2019-ncov diagnostic p",
  "code_information": [
    {
      "code": "U0001",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 35.91,
      "maximum": 86.21,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 86.208,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.215745,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 51.6035,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.3738,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.8875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.91,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "22nf nonsealed leadacid",
  "code_information": [
    {
      "code": "E2360",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 106.53,
      "maximum": 106.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 106.53,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "22nf sealed leadacid battery",
  "code_information": [
    {
      "code": "E2361",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 128.24,
      "maximum": 128.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 128.24,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "2d cephal radio image",
  "code_information": [
    {
      "code": "D0702",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 111.88,
      "maximum": 268.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 170.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 151.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 151.3065,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.50312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 112.969,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.9288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.845375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.014034,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.9288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.9288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "2d cephalometric image",
  "code_information": [
    {
      "code": "D0340",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 111.88,
      "maximum": 268.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 151.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 170.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 151.3065,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.50312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 112.969,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.9288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.014034,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.845375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.9288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.9288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "2d oral/facial photo image",
  "code_information": [
    {
      "code": "D0703",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 111.88,
      "maximum": 268.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 151.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 170.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 151.3065,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.50312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 112.969,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.9288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.845375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.014034,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.9288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.9288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "2d tee w or w/o fol w/con,in",
  "code_information": [
    {
      "code": "C8925",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1003.85,
      "maximum": 2409.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1359.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1530.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1357.7115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2409.24048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1017.6235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1008.253,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1184.543236,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1254.81275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1008.253,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1008.253,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "2d tte w or w/o fol w/con,co",
  "code_information": [
    {
      "code": "C8923",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1003.85,
      "maximum": 2409.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1359.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1530.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1357.7115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2409.24048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1017.6235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1008.253,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1184.543236,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1254.81275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1008.253,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1008.253,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1003.8502,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "2VHPV VACCINE 3 DOSE IM",
  "code_information": [
    {
      "code": "90650",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 132.59,
      "maximum": 647.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 647.732216,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 135.116,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 135.116,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 397.2375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 132.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "3-D RADIOTHERAPY PLAN",
  "code_information": [
    {
      "code": "77295",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 429.75,
      "maximum": 4172.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1738.5112,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1738.5112,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2353.71,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2651.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2351.364,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1738.5112,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4172.42688,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1796.7682,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1780.2231,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2173.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2051.443216,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 429.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1738.5112,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1780.2231,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1780.2231,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1738.5112,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "361 hct/p skin subs, nos",
  "code_information": [
    {
      "code": "Q4433",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "365 d implant glucose sensor",
  "code_information": [
    {
      "code": "G0564",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3250.5,
      "maximum": 5162.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3250.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3250.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4873.500654,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5162.606625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4130.0853,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "3d anat seg imaging preop",
  "code_information": [
    {
      "code": "C8001",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 111.88,
      "maximum": 477.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 170.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 151.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.869,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 477.11544,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 167.0331,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.014034,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.845375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 111.8763,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "3d bn img algor drvd fr mri",
  "code_information": [
    {
      "code": "G0566",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 165.5,
      "maximum": 477.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.869,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 477.11544,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 167.0331,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "3D CNTR SIMULA TRGT LVR LES",
  "code_information": [
    {
      "code": "0944T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 306.88,
      "maximum": 737.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 307.1294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 307.1294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 415.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 468.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 415.397,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 307.1294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 737.11056,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 309.7342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 306.8821,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 362.412692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 383.91175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 307.1294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 306.8821,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 306.8821,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 307.1294,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "3D ECHO IMG CGEN CAR ANOMAL",
  "code_information": [
    {
      "code": "93319",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 55.05,
      "maximum": 55.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "4 em core sessions",
  "code_information": [
    {
      "code": "G9874",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 40.0,
      "maximum": 40.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "4-bar link above knee w/swng",
  "code_information": [
    {
      "code": "L5614",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1062.81,
      "maximum": 1062.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1062.81,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "4VHPV VACCINE 3 DOSE IM",
  "code_information": [
    {
      "code": "90649",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 163.24,
      "maximum": 629.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 629.459276,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 163.2425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 163.2425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 479.8682,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "5% dextrose and 0.45% saline",
  "code_information": [
    {
      "code": "S5010",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.35,
      "maximum": 21.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.352683,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.5605,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "5% dextrose in lac ringers",
  "code_information": [
    {
      "code": "J7121",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.57,
      "maximum": 21.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.568235,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.143,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.143,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.1057,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "5% dextrose in lactated ring",
  "code_information": [
    {
      "code": "S5011",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.85,
      "maximum": 49.95,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 49.946036,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.845,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.845,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "5% dextrose with potassium",
  "code_information": [
    {
      "code": "S5012",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.97,
      "maximum": 27.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.061354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.9737,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "5% dextrose/normal saline",
  "code_information": [
    {
      "code": "J7042",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.02,
      "maximum": 76.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.441799,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.0175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.0175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.103,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "5% dextrose/water",
  "code_information": [
    {
      "code": "J7060",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.38,
      "maximum": 43.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43.550507,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.3775,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.3775,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.09,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "5%dextrose/0.45%saline1000ml",
  "code_information": [
    {
      "code": "S5013",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.93,
      "maximum": 25.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.930172,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "510(k) skin subs, nos",
  "code_information": [
    {
      "code": "Q4432",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "9 em core sessions",
  "code_information": [
    {
      "code": "G9875",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 72.0,
      "maximum": 72.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "9VHPV VACCINE 2/3 DOSE IM",
  "code_information": [
    {
      "code": "90651",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 291.25,
      "maximum": 861.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 820.324485,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 335.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 335.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 861.457,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 291.25,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Abacavir 300 MG Tablet",
  "drug_information": {
    "unit": 300.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00378410591",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 24.36,
      "maximum": 116.0,
      "gross_charge": 116.0,
      "discounted_cash": 63.8,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.372,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.96,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.36,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 81.2,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 116.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.36,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 42.5024,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.7232,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72.036,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 69.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.6,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 110.2,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 110.2,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 116.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 115.42,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 116.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 63.8,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 63.8,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.4,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.356,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38.048,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.864,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38.976,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 113.1464,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 108.228,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 109.8288,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 105.0844,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 116.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 102.7296,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Abatacept injection",
  "code_information": [
    {
      "code": "J0129",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 41.21,
      "maximum": 116.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.31921,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.211,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 105.864,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 116.9777,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 54.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.2592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 47.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.1186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.44,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Abciximab injection",
  "code_information": [
    {
      "code": "J0130",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1375.15,
      "maximum": 3822.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2349.595535,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1375.147,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1375.147,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3822.7622,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ABD PARACENTESIS",
  "code_information": [
    {
      "code": "49082",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1166.53,
      "maximum": 2859.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1612.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1816.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1611.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2859.03288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1177.3761,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1166.5345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1405.691166,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1489.079625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1166.5345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1166.5345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABD PARACENTESIS W/IMAGING",
  "code_information": [
    {
      "code": "49083",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1166.53,
      "maximum": 2859.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1612.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1816.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1611.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2859.03288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1177.3761,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1166.5345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1489.079625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1405.691166,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1166.5345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1166.5345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1191.2637,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Abdominal pad",
  "code_information": [
    {
      "code": "L1270",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 56.61,
      "maximum": 56.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 56.61,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Abduct control hip semi-flex",
  "code_information": [
    {
      "code": "L1630",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 77.6,
      "maximum": 77.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.6,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Abduct rotation bar w/o shoe",
  "code_information": [
    {
      "code": "L3150",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 51.17,
      "maximum": 51.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 51.17,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Abduction bar jointed adjust",
  "code_information": [
    {
      "code": "L2300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 216.18,
      "maximum": 216.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 216.18,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Abduction bar-straight",
  "code_information": [
    {
      "code": "L2310",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 98.78,
      "maximum": 98.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 98.78,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Abduction rotation bar shoe",
  "code_information": [
    {
      "code": "L3140",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 55.97,
      "maximum": 55.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ABETA42 & PTAU181 ECLIA CSF",
  "code_information": [
    {
      "code": "0445U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 260.5,
      "maximum": 625.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 625.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABETA42 & TTAU ECLIA CSF",
  "code_information": [
    {
      "code": "0459U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 260.5,
      "maximum": 625.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 625.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Abio mem abio hyd per sq cm",
  "code_information": [
    {
      "code": "Q4356",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Abio xpl abio xpl hy p sq cm",
  "code_information": [
    {
      "code": "Q4355",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABL1 GENE",
  "code_information": [
    {
      "code": "81170",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 240.0,
      "maximum": 720.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 720.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 461.1165,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 430.95,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 240.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLATE BONE TUMOR(S) PERQ",
  "code_information": [
    {
      "code": "20982",
      "type": "HCPCS"
    },
    {
      "code": "20983",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLATE INF TURBINATE SUBMUC",
  "code_information": [
    {
      "code": "30802",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1882.11,
      "maximum": 4517.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2548.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2870.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2545.601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4517.07456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2014.1424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2220.894992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2352.643,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLATE INF TURBINATE SUPERF",
  "code_information": [
    {
      "code": "30801",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1882.11,
      "maximum": 4517.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2548.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2870.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2545.601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4517.07456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2014.1424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2220.894992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2352.643,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLATE PULM TUMOR PERQ CRYBL",
  "code_information": [
    {
      "code": "32994",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13228.5,
      "maximum": 31748.39,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13228.4961,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13228.4961,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 20173.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 17909.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17891.7585,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13228.4961,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31748.39064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13798.8049,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13671.7421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16535.620125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15609.625398,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13228.4961,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13671.7421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13671.7421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13228.4961,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLATE PULM TUMOR PERQ RF",
  "code_information": [
    {
      "code": "32998",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7413.14,
      "maximum": 17791.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.1378,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.1378,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11305.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10036.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10026.395,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.1378,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17791.53072,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7847.8228,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7775.5581,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8747.502604,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9266.42225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.1378,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7775.5581,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7775.5581,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7413.1378,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLT B9 BRST TUM PERQ LSR EA",
  "code_information": [
    {
      "code": "0970T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4865.48,
      "maximum": 11677.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11677.15968,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5082.7049,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5035.9021,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5035.9021,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5035.9021,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLT MAL BRST TUM PQ LSR UNI",
  "code_information": [
    {
      "code": "0971T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4865.48,
      "maximum": 11677.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11677.15968,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5082.7049,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5035.9021,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5035.9021,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5035.9021,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLT TRURL PRST8 TIS TRNSDCR",
  "code_information": [
    {
      "code": "55882",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16508.17,
      "maximum": 39619.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16508.1689,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16508.1689,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22349.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 25175.01,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22327.565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16508.1689,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39619.60536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17126.6969,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16968.9901,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20635.211125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19479.639302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16508.1689,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16968.9901,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16968.9901,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16508.1689,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ 1/+THYR NDUL 1LOBE PRQ",
  "code_information": [
    {
      "code": "60660",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2058.68,
      "maximum": 4940.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2787.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3139.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2784.3835,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4940.82456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2143.9723,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2124.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2429.238742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2573.346125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2124.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2124.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ B9 PRST8 TISSUE HIFU",
  "code_information": [
    {
      "code": "0950T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11749.43,
      "maximum": 28198.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11749.4288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11749.4288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11749.4288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28198.62912,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12288.6079,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12175.4514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12175.4514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12175.4514,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ B9 THYR NDUL PERQ LASR",
  "code_information": [
    {
      "code": "0673T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2058.68,
      "maximum": 4940.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3139.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2787.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2784.3835,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4940.82456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2143.9723,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2124.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2573.346125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2429.238742,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2124.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2124.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2058.6769,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ IRE LIVER 1+ TUM PERQ",
  "code_information": [
    {
      "code": "47384",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13671.74,
      "maximum": 13798.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13798.8049,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13671.7421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13671.7421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13671.7421,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ IRE PRST8 1+ TUM PERQ",
  "code_information": [
    {
      "code": "55877",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13671.74,
      "maximum": 13798.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13798.8049,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13671.7421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13671.7421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13671.7421,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ MAL BRST TUM PERQ CRTX",
  "code_information": [
    {
      "code": "0581T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4865.48,
      "maximum": 11677.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7419.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6587.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6580.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11677.15968,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5082.7049,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5035.9021,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6081.854,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5741.270176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5035.9021,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5035.9021,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4865.4832,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ MAL PRST8 TISS HIFU",
  "code_information": [
    {
      "code": "55880",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11749.43,
      "maximum": 28198.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11749.4288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11749.4288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 17917.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15907.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15891.2865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11749.4288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28198.62912,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12288.6079,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12175.4514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13864.325984,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14686.786,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11749.4288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12175.4514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12175.4514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11749.4288,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABLTJ PERC UXTR/PERPH NRV",
  "code_information": [
    {
      "code": "0440T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2481.19,
      "maximum": 5954.86,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2481.1896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2481.1896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3783.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3359.19,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3355.856,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2481.1896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5954.85504,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2534.8724,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2511.5307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2927.803728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3101.487,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2481.1896,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2511.5307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2511.5307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2481.1896,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABO GNOTYP ABO 7 EXONS",
  "code_information": [
    {
      "code": "0180U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 274.83,
      "maximum": 659.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 659.592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 422.430008,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 394.7944,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABO GNOTYP NEXT GNRJ SEQ ABO",
  "code_information": [
    {
      "code": "0221U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 274.83,
      "maximum": 659.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 659.592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 422.430008,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 394.7944,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Abobotulinumtoxina",
  "code_information": [
    {
      "code": "J0586",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.53,
      "maximum": 33.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.50039,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.588,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.9845,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.9845,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.4865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.1834,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.7875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.4862,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABORTION (MPR)",
  "code_information": [
    {
      "code": "59866",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 386.5,
      "maximum": 927.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 523.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 589.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 522.7565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 927.60912,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.5759,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.9333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 483.12975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.074484,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.9333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.9333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",
  "code_information": [
    {
      "code": "770",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10059.23,
      "maximum": 20718.79,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10059.23,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10059.23,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18394.5315,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20718.7901,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13117.1915,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10059.23,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16721.386172,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10059.23,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10059.23,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12456.6346,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13195.5875,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10556.47,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10059.23,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10556.47,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ABORTION WITHOUT D&C",
  "code_information": [
    {
      "code": "779",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8516.73,
      "maximum": 17383.78,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8516.73,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8516.73,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17383.7819,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15433.6485,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11395.858,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8516.73,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14029.821668,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8516.73,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8516.73,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10879.6472,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11525.05,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9220.04,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8516.73,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9220.04,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Above elbow myoelectronic ct",
  "code_information": [
    {
      "code": "L6955",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5262.83,
      "maximum": 5262.83,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5262.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Above elbow prosth tiss shap",
  "code_information": [
    {
      "code": "L6500",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2062.1,
      "maximum": 2062.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2062.1,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Above elbow switch control",
  "code_information": [
    {
      "code": "L6950",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4404.17,
      "maximum": 4404.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4404.17,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Above knee cushion socket",
  "code_information": [
    {
      "code": "L5648",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 220.79,
      "maximum": 220.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 220.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Above knee flex cover system",
  "code_information": [
    {
      "code": "L5964",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 502.11,
      "maximum": 502.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 502.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Above knee hydracadence",
  "code_information": [
    {
      "code": "L5610",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1572.18,
      "maximum": 1572.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1572.18,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Above knee leather socket",
  "code_information": [
    {
      "code": "L5642",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 134.48,
      "maximum": 134.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 134.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Above knee manual lock",
  "code_information": [
    {
      "code": "L5925",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 194.09,
      "maximum": 194.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 194.09,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Above knee wood socket",
  "code_information": [
    {
      "code": "L5644",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 134.48,
      "maximum": 134.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 134.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ABRASION LESION SINGLE",
  "code_information": [
    {
      "code": "15786",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 252.47,
      "maximum": 605.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 252.4682,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 252.4682,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 341.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 385.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 341.4775,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 252.4682,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 605.92368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.4476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.0493,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 315.58525,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 297.912476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 252.4682,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.0493,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.0493,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 252.4682,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Abraxane 100 MG Vial",
  "drug_information": {
    "unit": 100.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "68817013450",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 10759.0,
      "gross_charge": 10759.0,
      "discounted_cash": 5917.45,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 3518.193,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.027762,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10759.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.407,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6681.339,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.296,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2668.232,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2668.232,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 10759.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10705.205,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10759.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.7412,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.675,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4206.769,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3528.952,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4346.636,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3615.024,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 10494.3286,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10038.147,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.34,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 10186.6212,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9746.5781,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10759.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9528.1704,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ABSCESS DRAINAGE UNDER X-RAY",
  "code_information": [
    {
      "code": "75989",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 104.52,
      "maximum": 104.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 104.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Absolv3 per sq cm",
  "code_information": [
    {
      "code": "Q4401",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acamprosate Calc Dr 333 MG Tab",
  "drug_information": {
    "unit": 333.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00378633380",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.21,
      "maximum": 15.27,
      "gross_charge": 15.27,
      "discounted_cash": 8.4,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.36759,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.7337,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.2067,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.689,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.27,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.2067,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.965804,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.594928,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 9.162,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.48267,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.3445,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.5065,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.5065,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.27,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.19365,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.27,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.162,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.3985,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.3985,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.108,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.97057,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.00856,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.16908,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.13072,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.894358,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.24691,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.457636,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.833093,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.27,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.523112,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acapatch, per sq cm",
  "code_information": [
    {
      "code": "Q4325",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Accupril 10 MG Tablet",
  "drug_information": {
    "unit": 10.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00071053023",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.66,
      "maximum": 93.64,
      "gross_charge": 93.64,
      "discounted_cash": 51.5,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.04788,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.0284,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.6644,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.548,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.64,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.6644,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.451728,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.309696,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 58.15044,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 56.184,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.774,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.958,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.958,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.64,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.1718,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.64,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.184,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.502,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.502,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.456,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.61324,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.71392,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.83056,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.46304,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.336456,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 87.36612,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 88.658352,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 84.828476,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.64,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 82.927584,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Accupril 20 MG Tablet",
  "drug_information": {
    "unit": 20.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00071053223",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.4,
      "maximum": 92.4,
      "gross_charge": 92.4,
      "discounted_cash": 50.82,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38.5308,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.644,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.404,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.68,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 92.4,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.404,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.04848,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.85536,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.3804,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 55.44,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.34,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 87.78,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 87.78,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.4,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.938,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.4,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.44,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.82,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.82,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.96,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.1284,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.3072,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.3296,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.0464,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 90.12696,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 86.2092,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 87.48432,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 83.70516,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.4,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 81.82944,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acd-A Solution",
  "drug_information": {
    "unit": 500.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00942064103",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.01,
      "maximum": 66.72,
      "gross_charge": 66.72,
      "discounted_cash": 36.7,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.82224,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.6832,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.0112,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.704,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66.72,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.0112,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.697344,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.446208,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.352,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.43312,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 40.032,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.384,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.384,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 66.72,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 66.3864,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 66.72,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.032,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.696,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.696,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.688,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.08752,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.88416,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.95488,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.41792,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 65.078688,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.24976,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.170496,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.441648,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 66.72,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 59.087232,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acelagraft per sq cm",
  "code_information": [
    {
      "code": "Q4395",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acesso ac, per sq cm",
  "code_information": [
    {
      "code": "Q4312",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acesso dl, per sq cm",
  "code_information": [
    {
      "code": "Q4293",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 3399.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3399.2562,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Acesso tl, per sq cm",
  "code_information": [
    {
      "code": "Q4300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 4536.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4536.1312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Acesso trifaca per sq cm",
  "code_information": [
    {
      "code": "Q4386",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acesso, per sq cm",
  "code_information": [
    {
      "code": "Q4311",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acetadote 200 MG/Ml Vial",
  "drug_information": {
    "unit": 6000.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "66220020730",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 1835.0,
      "gross_charge": 1835.0,
      "discounted_cash": 1009.25,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 600.045,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 385.35,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1284.5,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1835.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 385.35,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 672.344,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 596.742,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 642.25,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1101.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1139.535,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 455.08,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 455.08,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1835.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1825.825,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1835.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1101.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1009.25,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1009.25,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 734.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 717.485,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 601.88,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 741.34,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 616.56,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1789.859,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1712.055,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1737.378,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1662.3265,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1835.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1625.076,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetaminophen 1 000 MG/100 Ml Vl",
  "drug_information": {
    "unit": 1000.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00781315606",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 366.0,
      "gross_charge": 366.0,
      "discounted_cash": 201.3,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 119.682,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 76.86,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 256.2,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 366.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 76.86,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 119.0232,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 134.1024,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 219.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 128.1,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 227.286,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 90.768,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 90.768,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 366.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 364.17,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 366.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 219.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 201.3,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 201.3,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 146.4,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 143.106,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 120.048,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 147.864,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 122.976,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 356.9964,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 341.478,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 346.5288,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 331.5594,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 366.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 324.1296,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetaminophen 160 MG/5 Ml Solution Cup",
  "drug_information": {
    "unit": 160.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00121065705",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.21,
      "maximum": 10.51,
      "gross_charge": 10.51,
      "discounted_cash": 5.78,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.38267,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.2581,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.2071,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.357,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.2071,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.417852,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.850864,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.6785,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.52671,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 6.306,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.9845,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.9845,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.51,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.45745,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.306,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.7805,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.7805,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.204,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.10941,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.44728,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.24604,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.53136,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.251454,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.80583,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.950868,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.521009,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.307656,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetaminophen 325 MG Tablet",
  "drug_information": {
    "unit": 325.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "10135012301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.71,
      "maximum": 3.36,
      "gross_charge": 3.36,
      "discounted_cash": 1.85,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.40112,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.0416,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.7056,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.352,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.36,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.7056,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.092672,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.231104,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.176,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.08656,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2.016,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.192,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.192,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.36,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.3432,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.36,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.016,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.848,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.848,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.344,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.31376,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.10208,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.35744,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.12896,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.277344,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.13488,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.181248,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.043824,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.36,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.975616,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetaminophen 325 MG/10.15 Ml Cup",
  "drug_information": {
    "unit": 650.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00121131400",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.75,
      "maximum": 3.56,
      "gross_charge": 3.56,
      "discounted_cash": 1.96,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.48452,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.1036,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.7476,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.492,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.7476,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.304384,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.157712,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.246,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.21076,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2.136,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.382,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.382,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.5422,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.136,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.424,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.39196,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.16768,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.19616,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.43824,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.472424,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.32148,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.370608,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.225004,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.152736,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetaminophen 650 MG Suppos",
  "drug_information": {
    "unit": 650.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "45802073030",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.75,
      "maximum": 3.56,
      "gross_charge": 3.56,
      "discounted_cash": 1.96,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.48452,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.1036,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.7476,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.492,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.7476,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.157712,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.304384,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.21076,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2.136,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.246,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.382,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.382,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.5422,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.136,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.424,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.39196,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.16768,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.43824,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.19616,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.472424,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.32148,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.370608,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.225004,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.152736,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetaminophen-Cod #3 Tablet",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00406048401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.59,
      "maximum": 36.15,
      "gross_charge": 36.15,
      "discounted_cash": 19.88,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.07455,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.2065,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.5915,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.305,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.15,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.5915,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.24536,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.75598,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.44915,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 21.69,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.6525,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.3425,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.3425,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.15,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35.96925,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.15,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.69,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.8825,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.8825,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.46,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.13465,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.8572,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.6046,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.1464,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 35.26071,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.72795,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.22682,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.748285,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.15,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.01444,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetaminophen-Codeine 300-30 MG/12.5 Ml Cup",
  "drug_information": {
    "unit": 12.5,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00121100800",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.29,
      "maximum": 15.68,
      "gross_charge": 15.68,
      "discounted_cash": 8.62,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.53856,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.8608,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.2928,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.976,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.68,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.2928,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.745152,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.099136,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.488,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.73728,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 9.408,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.896,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.896,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.68,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.6016,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.68,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.408,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.624,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.624,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.272,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.13088,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.14304,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.33472,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.26848,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.294272,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.62944,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.845824,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.204512,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.68,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.886208,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetazolamid sodium injectio",
  "code_information": [
    {
      "code": "J1120",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 30.78,
      "maximum": 142.83,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 142.833481,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.7115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.7115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.78,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Acetazolamide 250 MG Tablet",
  "drug_information": {
    "unit": 250.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "51672402301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.25,
      "maximum": 63.09,
      "gross_charge": 63.09,
      "discounted_cash": 34.7,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.30853,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.5579,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.2489,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.163,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.09,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.2489,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.116176,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 20.516868,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 37.854,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.17889,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.0815,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.9355,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.9355,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.09,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.77455,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.09,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.854,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.6995,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.6995,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.236,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.66819,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.69352,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.48836,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.19824,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 61.537986,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.86297,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 59.733612,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.153231,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.09,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 55.872504,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetazolamide Sod 500 MG Vial",
  "drug_information": {
    "unit": 500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00143950301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 452.0,
      "gross_charge": 452.0,
      "discounted_cash": 248.6,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 147.804,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.92,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 316.4,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 452.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.92,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 165.6128,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 146.9904,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 280.692,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 271.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 158.2,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 112.096,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 112.096,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 452.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 449.74,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 452.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 248.6,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 248.6,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 180.8,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 176.732,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 148.256,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 182.608,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 151.872,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 440.8808,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 421.716,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 427.9536,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 409.4668,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 452.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 400.2912,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetic Acid 0.25% Irrig Soln",
  "drug_information": {
    "unit": 2500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00338065604",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.75,
      "maximum": 74.98,
      "gross_charge": 74.98,
      "discounted_cash": 41.24,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.26666,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.2438,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.7458,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 52.486,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.98,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.7458,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.472672,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.383496,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.243,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.56258,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 44.988,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 71.231,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 71.231,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.98,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.6051,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.98,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.988,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.239,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.239,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.992,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.31718,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.59344,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.29192,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.19328,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 73.135492,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 69.95634,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 70.991064,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.924382,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.98,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 66.402288,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACETYLCHOLINESTERASE ASSAY",
  "code_information": [
    {
      "code": "82013",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.93,
      "maximum": 29.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.29,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.29,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.29,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.496,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.893953,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.6579,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.29,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.29,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.29,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.29,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACETYLCHOLN RCPTR BLCKG ANTB",
  "code_information": [
    {
      "code": "86042",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 18.4,
      "maximum": 44.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.281812,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.4316,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACETYLCHOLN RCPTR BNDNG ANTB",
  "code_information": [
    {
      "code": "86041",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 18.4,
      "maximum": 44.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.281812,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.4316,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACETYLCHOLN RCPTR MODLG ANTB",
  "code_information": [
    {
      "code": "86043",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.05,
      "maximum": 28.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.515601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.3043,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acetylcysteine 10% Vial (Not For Injection)",
  "drug_information": {
    "unit": 4.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "63323069504",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 72.08,
      "gross_charge": 72.08,
      "discounted_cash": 39.64,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 23.57016,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.1368,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.456,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72.08,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.1368,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.440416,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.410112,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.76168,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.228,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 43.248,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.87584,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.87584,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 72.08,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 71.7196,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 72.08,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.248,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.644,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.644,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.832,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.18328,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.64224,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.12032,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.21888,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 70.306832,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.25064,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 68.245344,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 65.297272,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 72.08,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.834048,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetylcysteine 20% Vial (Not For Injection)",
  "drug_information": {
    "unit": 4.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00517760425",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.92,
      "maximum": 32.94,
      "gross_charge": 32.94,
      "discounted_cash": 18.12,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.73598,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.2114,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.9174,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.058,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.94,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.9174,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12.069216,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.712088,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.45574,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 19.764,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.529,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.293,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.293,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.94,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.7753,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.94,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.764,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.117,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.117,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.176,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.87954,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.80432,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.30776,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.06784,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.73302,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.129676,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.187592,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.840346,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.94,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.171664,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acetylcysteine injection",
  "code_information": [
    {
      "code": "J0132",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.43,
      "maximum": 52.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 52.686977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.5247,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Acetylcysteine non-comp unit",
  "code_information": [
    {
      "code": "J7608",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.48,
      "maximum": 31.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.063998,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.4755,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.4755,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.3692,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ACHR ANTB ID IMFLUOR LIVECLL",
  "code_information": [
    {
      "code": "0545U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.73,
      "maximum": 37.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACID PERFUSION OF ESOPHAGUS",
  "code_information": [
    {
      "code": "91030",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 40.46,
      "maximum": 1618.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 674.1804,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 674.1804,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1028.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 912.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 911.8385,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 674.1804,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1618.03296,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 484.4035,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 479.943,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 795.532872,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 842.7255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 674.1804,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 479.943,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 479.943,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 674.1804,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACOUSTIC IMMITANCE TESTING",
  "code_information": [
    {
      "code": "92570",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 26.84,
      "maximum": 477.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 269.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 303.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.869,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 477.11544,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 167.0331,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 248.497625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 234.581758,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.84,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACOUSTIC REFL THRESHOLD TST",
  "code_information": [
    {
      "code": "92568",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.28,
      "maximum": 119.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.4595,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 119.69064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.4861,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 62.338875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.847898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACROMP/ACROMIONECTOMY PRTL",
  "code_information": [
    {
      "code": "23130",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Actemra 200 MG/10 Ml Vial",
  "drug_information": {
    "unit": 200.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "50242013601",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 3859.0,
      "gross_charge": 3859.0,
      "discounted_cash": 2122.45,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1261.893,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 810.39,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2701.3,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3859.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 810.39,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.551811,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12.886411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.7745,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1350.65,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2396.439,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6.7745,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 957.032,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 957.032,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3859.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3839.705,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3859.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2315.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2122.45,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2122.45,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1543.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1508.869,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1265.752,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1559.036,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1296.624,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3764.0686,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3600.447,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3653.7012,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3495.8681,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3859.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3417.5304,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Actemra 400 MG/20 Ml Vial",
  "drug_information": {
    "unit": 400.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "50242013701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 7718.0,
      "gross_charge": 7718.0,
      "discounted_cash": 4244.9,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2523.786,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1620.78,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5402.6,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7718.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1620.78,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2827.8752,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2509.8936,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2701.3,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4792.878,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 4630.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1914.064,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1914.064,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 7718.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7679.41,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7718.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4630.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4244.9,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4244.9,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3087.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3017.738,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2531.504,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3118.072,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2593.248,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7200.894,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 7528.1372,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 7307.4024,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6991.7362,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7718.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6835.0608,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACTH STIMULATION PANEL",
  "code_information": [
    {
      "code": "80400",
      "type": "HCPCS"
    },
    {
      "code": "80402",
      "type": "HCPCS"
    },
    {
      "code": "80406",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 32.62,
      "maximum": 208.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 86.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 78.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 86.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 78.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 86.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 78.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 78.288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 187.824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.13164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 133.652844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 120.292289,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.852,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 124.9092,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 112.4227,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 86.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 78.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 86.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 78.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 86.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 78.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 86.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 78.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 86.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 78.26,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acthib Vaccine With Diluent",
  "drug_information": {
    "unit": 0.5,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "49281054503",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 1100.0,
      "gross_charge": 1100.0,
      "discounted_cash": 605.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 359.7,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 231.0,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 118.121505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1100.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 231.0,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 403.04,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 357.72,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 385.0,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.3025,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 683.1,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.3025,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 272.8,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 272.8,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1100.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1094.5,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1100.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 660.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 605.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 605.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 430.1,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 360.8,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 444.4,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 369.6,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1072.94,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1026.3,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1041.48,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 996.49,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1100.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 974.16,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Actidose 50 Gm Liquid",
  "drug_information": {
    "unit": 50.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "00574052076",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.4,
      "maximum": 240.0,
      "gross_charge": 240.0,
      "discounted_cash": 132.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.08,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.4,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.4,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 168.0,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 240.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.4,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 78.048,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 87.936,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 84.0,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 149.04,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 144.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 228.0,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 228.0,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 240.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 238.8,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 240.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 144.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 96.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.84,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 78.72,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 96.96,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.64,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 234.096,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 223.92,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 227.232,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 217.416,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 240.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 212.544,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACTIGRAPHY TESTING",
  "code_information": [
    {
      "code": "95803",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.47,
      "maximum": 181.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 115.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 102.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 102.068,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 181.13664,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 76.5791,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.8739,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 89.058848,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.8739,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.8739,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACTIN ANTIBODY EACH",
  "code_information": [
    {
      "code": "86015",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.53,
      "maximum": 28.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.515601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.3043,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACTINOTHERAPY UV LIGHT",
  "code_information": [
    {
      "code": "96900",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.4,
      "maximum": 119.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.4595,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 119.69064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.4861,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.847898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 62.338875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Activase 100 MG Vial",
  "drug_information": {
    "unit": 100.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "50242008527",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 59865.0,
      "gross_charge": 59865.0,
      "discounted_cash": 32925.75,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 10796.0,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12571.65,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold",
          "standard_charge_dollar": 25622.22,
          "standard_charge_percentage": 42.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59865.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12571.65,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21934.536,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 19468.098,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20952.75,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37176.165,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 11961.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14846.52,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14846.52,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 59865.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 59565.675,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 59865.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35919.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32925.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32925.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23946.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23407.215,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19635.72,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24185.46,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20114.64,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 58392.321,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 55854.045,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 56680.182,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 54231.7035,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 59865.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53016.444,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Activase 50 MG Vial",
  "drug_information": {
    "unit": 50.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "50242004413",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 29933.0,
      "gross_charge": 29933.0,
      "discounted_cash": 16463.15,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 9788.091,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6285.93,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20953.1,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29933.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6285.93,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10967.4512,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9734.2116,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10476.55,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18588.393,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 11961.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7423.384,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7423.384,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 29933.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29783.335,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29933.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17959.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16463.15,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16463.15,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11973.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11703.803,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9818.024,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12092.932,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10057.488,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 29196.6482,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27927.489,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 28340.5644,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27116.3047,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29933.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26508.6648,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Activate matrix, per sq cm",
  "code_information": [
    {
      "code": "Q4301",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 7339.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7339.665,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ACTIVE THRC IRRIGATION SPX",
  "code_information": [
    {
      "code": "1021T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 806.82,
      "maximum": 814.31,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 814.3148,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 806.8164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 806.8164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 806.8164,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acular 0.5% Eye Drops",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00023218105",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 171.99,
      "maximum": 819.0,
      "gross_charge": 819.0,
      "discounted_cash": 450.45,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 341.523,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 253.89,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.99,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 573.3,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 819.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.99,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 266.3388,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 300.0816,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 286.65,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 508.599,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 491.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 778.05,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 778.05,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 819.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 814.905,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 819.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 491.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 450.45,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 450.45,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 327.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 320.229,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 268.632,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 330.876,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 275.184,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 798.8526,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 764.127,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 775.4292,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 741.9321,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 819.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 725.3064,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACUP 1/> W/ESTIM 1ST 15 MIN",
  "code_information": [
    {
      "code": "97813",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.0,
      "maximum": 74.68,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 42.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.0945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.6808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.5462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.71806,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.89625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUP 1/> W/ESTIM EA ADDL 15",
  "code_information": [
    {
      "code": "97814",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.0,
      "maximum": 20.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION",
  "code_information": [
    {
      "code": "880",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9445.3,
      "maximum": 19840.61,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9653.06,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9653.06,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17614.869,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19840.6126,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11685.9975,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9653.06,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16012.640872,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9653.06,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9653.06,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11806.625,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11145.454,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9445.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9653.06,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9445.3,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC",
  "code_information": [
    {
      "code": "289",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15295.48,
      "maximum": 35269.67,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16789.29,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16789.29,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31313.0805,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35269.6747,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19221.065,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16789.29,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28464.878884,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16789.29,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16789.29,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19119.35,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18048.6664,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15295.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16789.29,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15295.48,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC",
  "code_information": [
    {
      "code": "288",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 26225.42,
      "maximum": 55918.21,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26339.63,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26339.63,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 49645.239,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55918.2106,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33298.8775,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26339.63,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45129.565432,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26339.63,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26339.63,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32781.775,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30945.9956,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26225.42,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26339.63,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26225.42,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "290",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9361.57,
      "maximum": 19210.39,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9361.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9361.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17055.3465,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19210.3911,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11934.6885,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9361.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15504.011892,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9361.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9361.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11373.2884,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12047.975,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9638.38,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9361.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9638.38,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE GI BLOOD LOSS IMAGING",
  "code_information": [
    {
      "code": "78278",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 129.8,
      "maximum": 1225.36,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 510.5652,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 510.5652,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 691.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 778.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 690.5455,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 510.5652,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1225.35648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 518.9512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 514.1725,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 638.2065,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 602.466936,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 129.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 510.5652,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 514.1725,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 514.1725,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 510.5652,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE HEPATITIS PANEL",
  "code_information": [
    {
      "code": "80074",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 41.79,
      "maximum": 114.31,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.63,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.63,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.63,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 114.312,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.211112,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 68.4216,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.63,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.63,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.63,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE LEUKEMIA WITH OTHER PROCEDURES",
  "code_information": [
    {
      "code": "850",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 83235.48,
      "maximum": 178931.25,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 83235.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 83235.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 158858.5275,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 178931.2485,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 112299.462,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 83235.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 144408.93942,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 83235.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 83235.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 103322.0036,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 109451.275,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 87561.02,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 83235.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 87561.02,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC",
  "code_information": [
    {
      "code": "835",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20410.45,
      "maximum": 43098.89,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38264.001,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43098.8854,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34783.551688,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC",
  "code_information": [
    {
      "code": "834",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 52687.07,
      "maximum": 113437.8,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 113437.8037,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100712.2155,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 91551.548764,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "836",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12131.2,
      "maximum": 25198.53,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22371.7275,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25198.5285,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20336.82102,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC",
  "code_information": [
    {
      "code": "121",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11381.8,
      "maximum": 41130.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11594.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11594.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21340.7385,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24037.2679,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14180.213,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11594.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19399.609588,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 41130.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11594.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11594.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13430.524,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14227.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11381.8,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11594.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11381.8,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "122",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6792.32,
      "maximum": 16236.99,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7986.31,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7986.31,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14415.501,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16236.9854,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8268.952,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7986.31,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13104.283688,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7986.31,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7986.31,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8014.9376,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8490.4,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6792.32,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7986.31,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6792.32,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",
  "code_information": [
    {
      "code": "281",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9097.0,
      "maximum": 44132.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44132.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9260.27,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9260.27,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16860.8895,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18991.3633,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11237.379,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9260.27,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15327.242476,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9260.27,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9260.27,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10734.46,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11371.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9097.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9260.27,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9097.0,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",
  "code_information": [
    {
      "code": "280",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15806.83,
      "maximum": 44132.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44132.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15806.83,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15806.83,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33145.5183,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29427.2145,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20009.8025,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15806.83,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26750.549076,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15806.83,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15806.83,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19884.825,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18771.2748,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15907.86,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15806.83,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15907.86,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "282",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7235.27,
      "maximum": 44132.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44132.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7387.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7387.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13265.2695,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14941.4153,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8839.4745,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7387.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12058.675916,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7387.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7387.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8537.6186,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9044.0875,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7235.27,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7387.09,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7235.27,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",
  "code_information": [
    {
      "code": "284",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7091.78,
      "maximum": 44132.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44132.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7091.78,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7091.78,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12698.409,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14302.9286,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9033.303,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7091.78,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11543.376392,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7091.78,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7091.78,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8715.1968,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9232.2,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7385.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7091.78,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7385.76,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",
  "code_information": [
    {
      "code": "283",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 18879.8,
      "maximum": 44132.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44132.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19406.96,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19406.96,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40929.2704,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36337.776,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23837.685,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19406.96,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33032.533888,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19406.96,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19406.96,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23599.75,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22278.164,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18879.8,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19406.96,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18879.8,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "285",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5685.89,
      "maximum": 44132.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44132.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6200.11,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6200.11,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10986.8205,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12375.0707,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6843.857,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6200.11,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9987.472004,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6200.11,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6200.11,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7107.3625,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6709.3502,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.89,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6200.11,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5685.89,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACUTE VENOUS THROMBUS IMAGE",
  "code_information": [
    {
      "code": "78456",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 148.64,
      "maximum": 3980.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2245.71,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2529.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2243.4725,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3980.98296,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1680.6099,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1665.1344,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2073.428625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1957.316622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 148.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1665.1344,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1665.1344,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Acyclovir 200 MG Capsule",
  "drug_information": {
    "unit": 200.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00904578961",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.75,
      "maximum": 79.76,
      "gross_charge": 79.76,
      "discounted_cash": 43.87,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.25992,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.7256,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.7496,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.832,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 79.76,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.7496,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 25.937952,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.224064,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 49.53096,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 47.856,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.916,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.772,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.772,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 79.76,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 79.3612,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 79.76,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.856,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.868,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.868,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.904,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.18616,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.16128,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.22304,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.79936,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 77.797904,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.41608,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 75.516768,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 72.254584,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 79.76,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 70.635456,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acyclovir 5% Ointment",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00378870006",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 8261.0,
      "gross_charge": 8261.0,
      "discounted_cash": 4543.55,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2701.347,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1734.81,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5782.7,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8261.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1734.81,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2686.4772,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3026.8304,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5130.081,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 4956.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2891.35,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2048.728,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2048.728,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 8261.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8219.695,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8261.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4956.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4543.55,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4543.55,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3304.4,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3230.051,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2709.608,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3337.444,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2775.696,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 8057.7794,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7707.513,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 7821.5148,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7483.6399,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8261.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7315.9416,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acyclovir 500 MG/10 Ml Vial",
  "drug_information": {
    "unit": 500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "63323032510",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 1085.0,
      "gross_charge": 1085.0,
      "discounted_cash": 596.75,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 354.795,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 227.85,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 759.5,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1085.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 227.85,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 397.544,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 352.842,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 379.75,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 673.785,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 651.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 269.08,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 269.08,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1085.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1079.575,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1085.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 651.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 596.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 596.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 434.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 424.235,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 355.88,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 438.34,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 364.56,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1058.309,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1012.305,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1027.278,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 982.9015,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1085.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 960.876,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acyclovir 800 MG Tablet",
  "drug_information": {
    "unit": 800.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "10544020435",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 34.44,
      "maximum": 164.0,
      "gross_charge": 164.0,
      "discounted_cash": 90.2,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 68.388,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.84,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.44,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 114.8,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.44,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.3328,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.0896,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.844,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 98.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.4,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 155.8,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 155.8,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 164.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 163.18,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 164.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 98.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.2,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.2,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.124,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 53.792,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66.256,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.104,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 159.9656,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 153.012,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 155.2752,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 148.5676,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 164.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 145.2384,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Acyclovir Sodium 500 MG Vial",
  "drug_information": {
    "unit": 5.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "55390061210",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.12,
      "maximum": 67.39,
      "gross_charge": 67.39,
      "discounted_cash": 37.06,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 22.03653,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.1519,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 0.609098,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 67.39,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.1519,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.915228,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.691696,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.84919,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.119,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.119,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.5865,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.71272,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.71272,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.05305,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.39,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.39,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.434,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.0645,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.0645,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.34949,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.10392,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.22556,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.64304,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 65.732206,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.87487,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.804852,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 61.048601,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.39,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 59.680584,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ACYLCARNITINES QUAL",
  "code_information": [
    {
      "code": "82016",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.19,
      "maximum": 39.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.49,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.49,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.49,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.576,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.349584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.6912,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.49,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.49,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.19,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.49,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ACYLCARNITINES QUANT",
  "code_information": [
    {
      "code": "82017",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.99,
      "maximum": 40.49,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.940759,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.2437,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adacel Tdap Syringe",
  "drug_information": {
    "unit": 0.5,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "49281040020",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 989.0,
      "gross_charge": 989.0,
      "discounted_cash": 543.95,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 323.403,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 207.69,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 202.960155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 989.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 207.69,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 321.6228,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 362.3696,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 49.3425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 346.15,
          "standard_charge_percentage": 35.0,
          "median_amount": 21.94,
          "10th_percentile": 11.25,
          "90th_percentile": 32.63,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 614.169,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 49.3425,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 245.272,
          "standard_charge_percentage": 24.8,
          "median_amount": 88.26,
          "10th_percentile": 69.95,
          "90th_percentile": 88.28,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "median_amount": 88.26,
          "10th_percentile": 69.95,
          "90th_percentile": 88.28,
          "count": "1 through 10",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 245.272,
          "standard_charge_percentage": 24.8,
          "median_amount": 88.26,
          "10th_percentile": 69.95,
          "90th_percentile": 88.28,
          "count": "18",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "median_amount": 88.26,
          "10th_percentile": 69.95,
          "90th_percentile": 88.28,
          "count": "18",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 989.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 984.055,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 989.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 593.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 543.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 543.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 386.699,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 324.392,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 399.556,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 332.304,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 964.6706,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 922.737,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 936.3852,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 895.9351,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 989.0,
          "standard_charge_percentage": 100.0,
          "median_amount": 88.26,
          "10th_percentile": 58.33,
          "90th_percentile": 88.26,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 875.8584,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Adalimumab injection",
  "code_information": [
    {
      "code": "J0135",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1110.99,
      "maximum": 2773.99,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1110.994752,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2773.992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2773.992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2432.1635,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ADAPT BEHAVIOR TX PHYS/QHP",
  "code_information": [
    {
      "code": "97155",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 204.15,
      "maximum": 489.95,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 311.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 276.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 276.1175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 489.95352,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 230.4106,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 228.2889,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.184125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 240.893814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 228.2889,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 228.2889,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADAPT BHV TX EA 15 MIN",
  "code_information": [
    {
      "code": "0373T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.85,
      "maximum": 90.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.1955,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.84288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.6386,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.314,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.664416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADAPTIVE BEHAVIOR TX BY TECH",
  "code_information": [
    {
      "code": "97153",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 117.53,
      "maximum": 282.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 179.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 159.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 158.973,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.0732,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.8756,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 138.68599,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 146.913125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adcetris 50 MG Vial",
  "drug_information": {
    "unit": 50.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "51144005001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 44822.0,
      "gross_charge": 44822.0,
      "discounted_cash": 24652.1,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 10796.0,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold",
          "standard_charge_dollar": 19183.816,
          "standard_charge_percentage": 42.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44822.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 248.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 248.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.4835,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27834.462,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 258.587,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 258.587,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 620.736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11115.856,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11115.856,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 44822.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 44597.89,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 44822.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 283.0348,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 299.825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 226.57,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 316.2905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14701.616,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17525.402,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18108.088,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15060.192,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 43719.3788,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 41818.926,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 239.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 42437.4696,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 40604.2498,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 44822.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 39694.3632,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Add le poly knee custom kafo",
  "code_information": [
    {
      "code": "L2387",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 132.88,
      "maximum": 132.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 132.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Add proc construct new crown",
  "code_information": [
    {
      "code": "D2971",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Add pwr joystick",
  "code_information": [
    {
      "code": "E0983",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2862.96,
      "maximum": 2862.96,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2862.96,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Add pwr leg elevation",
  "code_information": [
    {
      "code": "E1010",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1143.79,
      "maximum": 1143.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1143.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Add pwr tiller",
  "code_information": [
    {
      "code": "E0984",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1623.99,
      "maximum": 1623.99,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1623.99,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Add ue prost a/e acrylic",
  "code_information": [
    {
      "code": "L7404",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 350.06,
      "maximum": 350.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 350.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Add ue prost a/e ultlite mat",
  "code_information": [
    {
      "code": "L7401",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 216.1,
      "maximum": 216.1,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 216.1,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Add ue prost b/e acrylic",
  "code_information": [
    {
      "code": "L7403",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 231.94,
      "maximum": 231.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 231.94,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Add ue prost be/wd, ultlite",
  "code_information": [
    {
      "code": "L7400",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 193.03,
      "maximum": 193.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 193.03,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Add ue prost s/d acrylic",
  "code_information": [
    {
      "code": "L7405",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 457.84,
      "maximum": 457.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 457.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Add ue prost s/d ultlite mat",
  "code_information": [
    {
      "code": "L7402",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 233.38,
      "maximum": 233.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 233.38,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ADDING WALKER TO PREV CAST",
  "code_information": [
    {
      "code": "29440",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Additional switch, ext power",
  "code_information": [
    {
      "code": "L6611",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 270.47,
      "maximum": 270.47,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 270.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Adenoscan 3 MG/Ml Vial",
  "drug_information": {
    "unit": 90.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00469087130",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 3108.0,
      "gross_charge": 3108.0,
      "discounted_cash": 1709.4,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1016.316,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 652.68,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2175.6,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3108.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 652.68,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1010.7216,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1138.7712,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1087.8,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1930.068,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1864.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 770.784,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 770.784,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3108.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3092.46,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3108.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1864.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1709.4,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1709.4,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1243.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1215.228,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1019.424,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1255.632,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1044.288,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3031.5432,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2899.764,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2942.6544,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2815.5372,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3108.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2752.4448,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Adenosine 6 MG/2 Ml Syringe",
  "drug_information": {
    "unit": 6.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "25021030167",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 873.0,
      "gross_charge": 873.0,
      "discounted_cash": 480.15,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 285.471,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 183.33,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 611.1,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 873.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 183.33,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 283.8996,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 319.8672,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 542.133,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 523.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 305.55,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 216.504,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 216.504,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 873.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 868.635,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 873.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 523.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 480.15,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 480.15,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 349.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 341.343,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 286.344,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 352.692,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 293.328,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 851.5242,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 814.509,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 826.5564,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 790.8507,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 873.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 773.1288,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Adenosine 60 MG/20 Ml Vial",
  "drug_information": {
    "unit": 60.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "23155025831",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 563.0,
      "gross_charge": 563.0,
      "discounted_cash": 309.65,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 184.101,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 118.23,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.441019,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 563.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 118.23,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 183.0876,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 206.2832,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.887,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 197.05,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 349.623,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.887,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 139.624,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 139.624,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 563.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 560.185,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 563.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 309.65,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 309.65,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 220.133,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 184.664,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 227.452,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.168,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 549.1502,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 525.279,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 533.0484,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 510.0217,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 563.0,
          "standard_charge_percentage": 100.0,
          "median_amount": 40.0,
          "10th_percentile": 40.0,
          "90th_percentile": 40.0,
          "count": "1 through 10",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 498.5928,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Adenosine injection",
  "code_information": [
    {
      "code": "J0152",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 328.3,
      "maximum": 328.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 328.303822,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ADENOVIRUS AG IA",
  "code_information": [
    {
      "code": "87301",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.1,
      "maximum": 28.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.752,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.421013,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.2159,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADENOVIRUS AG IF",
  "code_information": [
    {
      "code": "87260",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.1,
      "maximum": 34.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.632,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.180886,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.7298,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.43,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADENOVIRUS ANTIBODY",
  "code_information": [
    {
      "code": "86603",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.44,
      "maximum": 30.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.888,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.792539,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.4977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADENOVIRUS ASSAY W/OPTIC",
  "code_information": [
    {
      "code": "87809",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.1,
      "maximum": 52.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.224,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.436858,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.2494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adj motion knee jnt lerman t",
  "code_information": [
    {
      "code": "L2186",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 61.32,
      "maximum": 61.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 61.32,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Adj skin pro w/c cus wd<22in",
  "code_information": [
    {
      "code": "E2622",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 299.68,
      "maximum": 299.68,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 299.68,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Adj skin pro wc cus wd>=22in",
  "code_information": [
    {
      "code": "E2623",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 381.33,
      "maximum": 381.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 381.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Adj skin pro/pos cus<22in",
  "code_information": [
    {
      "code": "E2624",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 302.14,
      "maximum": 302.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 302.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Adj skin pro/pos wc cus>=22",
  "code_information": [
    {
      "code": "E2625",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 382.49,
      "maximum": 382.49,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 382.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ADJMT/REVJ EXT FIXJ SYS ANES",
  "code_information": [
    {
      "code": "20693",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adjust knee ext & flex dev",
  "code_information": [
    {
      "code": "E1810",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1195.97,
      "maximum": 1195.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1195.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Adjustable angle footplate",
  "code_information": [
    {
      "code": "K0040",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.88,
      "maximum": 63.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Adm of soc dtr assess 5-15 m",
  "code_information": [
    {
      "code": "G0136",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.85,
      "maximum": 90.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.1955,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.84288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.6386,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.664416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.314,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adm tocilizu covid-19 1st",
  "code_information": [
    {
      "code": "M0249",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 427.98,
      "maximum": 1373.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 450.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 450.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 427.975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1373.77272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 567.1345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 715.506625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 675.438254,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 567.1345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 567.1345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adm tocilizu covid-19 2nd",
  "code_information": [
    {
      "code": "M0250",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 427.98,
      "maximum": 1373.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 450.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 450.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 427.975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1373.77272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 567.1345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 715.506625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 675.438254,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 567.1345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 567.1345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.4053,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Admin + supply, tositumomab",
  "code_information": [
    {
      "code": "G3001",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10664.57,
      "maximum": 10664.57,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10664.566361,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ADMIN ECG CONTRAST AGENT",
  "code_information": [
    {
      "code": "93352",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 34.77,
      "maximum": 34.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.77,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ADMN SARSCOV2 VAC 1/ONLY CMP",
  "code_information": [
    {
      "code": "90480",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 30.42,
      "maximum": 126.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.7553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.7553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 80.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 71.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.7553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.4215,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.4215,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 126.61272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.7553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.2695,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 65.944125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 62.251254,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.7553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.2695,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.2695,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.7553,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADRC THER PRTL RC TEAR",
  "code_information": [
    {
      "code": "0717T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4557.82,
      "maximum": 11163.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6297.66,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7093.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6291.394,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11163.9084,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4600.1819,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4557.8223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5488.92163,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5814.535625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4557.8223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4557.8223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADRC THER PRTL RC TEAR NJX",
  "code_information": [
    {
      "code": "0718T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4557.82,
      "maximum": 11163.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6297.66,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7093.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6291.394,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11163.9084,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4600.1819,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4557.8223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5814.535625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5488.92163,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4557.8223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4557.8223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4651.6285,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC",
  "code_information": [
    {
      "code": "614",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 21423.49,
      "maximum": 45289.16,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21423.49,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21423.49,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45289.1634,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40208.571,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27782.5885,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21423.49,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36551.245848,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21423.49,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21423.49,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27428.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25892.268,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21942.6,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21423.49,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21942.6,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "615",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13849.55,
      "maximum": 28913.74,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13849.55,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13849.55,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28913.7359,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25670.1585,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17469.265,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13849.55,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23335.230548,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13849.55,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13849.55,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16443.7602,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17419.2375,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13935.39,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13849.55,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13935.39,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ADRENAL CORTEX & MEDULLA IMG",
  "code_information": [
    {
      "code": "78075",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 217.82,
      "maximum": 3980.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2245.71,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2529.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2243.4725,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3980.98296,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1680.6099,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1665.1344,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2073.428625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1957.316622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 217.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1665.1344,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1665.1344,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1658.7429,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adrenalin 1 MG/Ml Nasal Soln",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "42023010301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 41.58,
      "maximum": 198.0,
      "gross_charge": 198.0,
      "discounted_cash": 108.9,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 82.566,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 61.38,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.58,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 138.6,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 198.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.58,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 72.5472,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 64.3896,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.3,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 122.958,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 118.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 188.1,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 188.1,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 198.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 197.01,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 198.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 118.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.9,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 108.9,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 79.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.418,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.944,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 79.992,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66.528,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 193.1292,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 184.734,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 187.4664,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 179.3682,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 198.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 175.3488,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Adrenalin 1 MG/Ml Vial",
  "drug_information": {
    "unit": 1.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "42023015901",
      "type": "NDC"
    },
    {
      "code": "42023015925",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 100.57,
      "gross_charge": 100.57,
      "discounted_cash": 55.31,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 32.88639,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.1197,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 70.399,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.57,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.1197,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.848848,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.705364,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.45397,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 60.342,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.1995,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.94136,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.94136,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 100.57,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 100.06715,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 100.57,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.342,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.3135,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.3135,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.228,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.32287,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.98696,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.63028,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.79152,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 98.095978,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.83181,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 95.219676,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.106363,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 100.57,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.064792,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Adrenalin 30 MG/30 Ml Vial",
  "drug_information": {
    "unit": 10.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "42023016801",
      "type": "NDC"
    },
    {
      "code": "42023016801_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 100.57,
      "gross_charge": 100.57,
      "discounted_cash": 55.31,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 32.88639,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.1197,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 70.399,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.57,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.1197,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.848848,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.705364,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.1995,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.45397,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 60.342,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.94136,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.94136,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 100.57,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 100.06715,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 100.57,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.342,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.3135,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.3135,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.228,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.32287,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.98696,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.63028,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.79152,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 98.095978,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.83181,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 95.219676,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.106363,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 100.57,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.064792,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    },
    {
      "minimum": 0.47,
      "maximum": 642.0,
      "gross_charge": 642.0,
      "discounted_cash": 353.1,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 209.934,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 134.82,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 449.4,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 642.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 134.82,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 208.7784,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 235.2288,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 398.682,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 385.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 224.7,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 159.216,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 159.216,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 642.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 638.79,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 642.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 385.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 353.1,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 353.1,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 256.8,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 251.022,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 210.576,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 259.368,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 215.712,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 626.2068,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 598.986,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 607.8456,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 581.5878,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 642.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 568.5552,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Adrenalin epinephrine inject",
  "code_information": [
    {
      "code": "J0171",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.4,
      "maximum": 5.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.131843,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4025,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4025,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.1667,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.24,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ADRNL CORTCL TUM BCHM ASY 25",
  "code_information": [
    {
      "code": "0015M",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1305.37,
      "maximum": 3132.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1305.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1305.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1305.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3132.888,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2006.424303,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1875.1629,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1305.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1305.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1305.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1305.37,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adult electric hand",
  "code_information": [
    {
      "code": "L7007",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2302.63,
      "maximum": 2302.63,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2302.63,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Adult electric hook",
  "code_information": [
    {
      "code": "L7009",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2349.42,
      "maximum": 2349.42,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2349.42,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Adv prim care mgmt lvl 1",
  "code_information": [
    {
      "code": "G0556",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.85,
      "maximum": 90.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.1955,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.84288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.6386,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.664416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.314,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adv prim care mgmt lvl 2",
  "code_information": [
    {
      "code": "G0557",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.85,
      "maximum": 90.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.1955,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.84288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.6386,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.664416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.314,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Adv prim care mgmt lvl 3",
  "code_information": [
    {
      "code": "G0558",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 117.53,
      "maximum": 282.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 159.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 179.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 158.973,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.0732,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.8756,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 138.68599,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 146.913125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Advair 100-50 Diskus",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00173069504",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 272.58,
      "maximum": 1298.0,
      "gross_charge": 1298.0,
      "discounted_cash": 713.9,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 541.266,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 402.38,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 272.58,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 908.6,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1298.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 272.58,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 422.1096,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 475.5872,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 806.058,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 778.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 454.3,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1233.1,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1233.1,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1298.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1291.51,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1298.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 778.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 713.9,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 713.9,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 519.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 507.518,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 425.744,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 524.392,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 436.128,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1266.0692,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1211.034,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1228.9464,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1175.8582,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1298.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1149.5088,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Advair 250-50 Diskus",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00173069604",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 333.69,
      "maximum": 1589.0,
      "gross_charge": 1589.0,
      "discounted_cash": 873.95,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 662.613,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 492.59,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 333.69,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1112.3,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1589.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 333.69,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 516.7428,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 582.2096,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 986.769,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 953.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 556.15,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1509.55,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1509.55,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1589.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1581.055,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1589.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 953.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 873.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 873.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 635.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 621.299,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 521.192,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 641.956,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 533.904,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1549.9106,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1482.537,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1504.4652,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1439.4751,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1589.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1407.2184,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Advair 500-50 Diskus",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00173069704",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 464.1,
      "maximum": 2210.0,
      "gross_charge": 2210.0,
      "discounted_cash": 1215.5,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 921.57,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 685.1,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 464.1,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1547.0,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2210.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 464.1,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 718.692,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 809.744,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1372.41,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1326.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 773.5,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2099.5,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2099.5,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2210.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2198.95,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2210.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1326.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1215.5,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1215.5,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 884.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 864.11,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 724.88,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 892.84,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 742.56,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2155.634,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2061.93,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2092.428,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2002.039,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2210.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1957.176,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Advanced life support mileag",
  "code_information": [
    {
      "code": "A0390",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.3,
      "maximum": 1.3,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.3,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Advograft dual per sq cm",
  "code_information": [
    {
      "code": "Q4382",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Advograft one per sq cm",
  "code_information": [
    {
      "code": "Q4380",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AEP HEARING STATUS DETER I&R",
  "code_information": [
    {
      "code": "92651",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 80.62,
      "maximum": 949.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 535.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 603.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 535.135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 949.59552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.2944,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 494.581,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 466.884464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AEP NEURODIAGNOSTIC I&R",
  "code_information": [
    {
      "code": "92653",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 76.92,
      "maximum": 949.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 603.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 535.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 535.135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 949.59552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.2944,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 494.581,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 466.884464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AEP SCR AUDITORY POTENTIAL",
  "code_information": [
    {
      "code": "92650",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.68,
      "maximum": 25.68,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.68,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AEP THRSHLD EST MLT FREQ I&R",
  "code_information": [
    {
      "code": "92652",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 104.64,
      "maximum": 949.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 603.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 535.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 535.135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 949.59552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.2944,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 494.581,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 466.884464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 104.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aeroguard per sq cm",
  "code_information": [
    {
      "code": "Q4370",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AEROSOL INHALATION TREATMENT",
  "code_information": [
    {
      "code": "94642",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 85.9,
      "maximum": 620.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.4273,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.4273,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 349.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 394.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 349.5335,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.4273,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 620.22552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 284.2586,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 281.6411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 323.034125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 304.944214,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 85.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.4273,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 281.6411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 281.6411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 258.4273,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aerosol mask used w nebulize",
  "code_information": [
    {
      "code": "A7015",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.79,
      "maximum": 1.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.79,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afamelanotide implant, 1 mg",
  "code_information": [
    {
      "code": "J7352",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2423.63,
      "maximum": 13267.37,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2943.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13267.372636,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2943.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2873.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2873.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2729.6635,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3213.5865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2943.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3213.5865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7064.208,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8109.7707,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2943.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2943.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3591.6625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3390.5294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2423.63,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3650.8531,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2943.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2943.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2873.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Afamitresgene autoleucel",
  "code_information": [
    {
      "code": "Q2057",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 732089.0,
      "maximum": 1849488.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 770620.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 770620.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 732089.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 741540.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 770620.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 741540.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1849488.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 770620.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 770620.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 979149.772,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 770620.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 770620.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AFF2 GEN ALY DETC ABNL ALLEL",
  "code_information": [
    {
      "code": "81171",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 109.6,
      "maximum": 328.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 328.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 210.576535,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 196.8005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 109.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AFF2 GEN ALYS CHARAC ALLELES",
  "code_information": [
    {
      "code": "81172",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 219.86,
      "maximum": 659.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 659.592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 422.430008,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 394.7944,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 219.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 274.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Affinity1 square cm",
  "code_information": [
    {
      "code": "Q4159",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 2856.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2856.974169,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 817.4265,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 175.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Aflibercept injection",
  "code_information": [
    {
      "code": "J0178",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 756.07,
      "maximum": 4346.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 771.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4346.218779,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 771.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 801.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 801.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 756.067,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 990.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 771.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 990.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1851.744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2234.695,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 763.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 763.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1027.475,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 969.9364,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 872.7,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1011.2197,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 763.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 763.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 821.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Afluria vacc, 3 yrs & >, im",
  "code_information": [
    {
      "code": "Q2035",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.32,
      "maximum": 51.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 51.164232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.8057,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo doub solid stirrup calf",
  "code_information": [
    {
      "code": "L1990",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 274.89,
      "maximum": 274.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 274.89,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo molded ankle gauntlet",
  "code_information": [
    {
      "code": "L1904",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.31,
      "maximum": 337.31,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 337.31,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo molded plas rig ant tib",
  "code_information": [
    {
      "code": "L1945",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 554.4,
      "maximum": 554.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 554.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo molded to patient plasti",
  "code_information": [
    {
      "code": "L1940",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 347.88,
      "maximum": 347.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 347.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo multilig ank sup pre ots",
  "code_information": [
    {
      "code": "L1906",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 96.56,
      "maximum": 96.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 96.56,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo plastic",
  "code_information": [
    {
      "code": "L1930",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 132.43,
      "maximum": 132.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 132.43,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo plastic molded w/ankle j",
  "code_information": [
    {
      "code": "L1970",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 449.28,
      "maximum": 449.28,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 449.28,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo pos solid ank plastic mo",
  "code_information": [
    {
      "code": "L1960",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 332.0,
      "maximum": 332.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 332.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo rig ant tib prefab tcf/=",
  "code_information": [
    {
      "code": "L1932",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 560.94,
      "maximum": 560.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 560.94,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo sing bar clasp attach sh",
  "code_information": [
    {
      "code": "L1910",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 147.95,
      "maximum": 147.95,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 147.95,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo sing solid stirrup calf",
  "code_information": [
    {
      "code": "L1980",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 235.66,
      "maximum": 235.66,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 235.66,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo sing upright w/ adjust s",
  "code_information": [
    {
      "code": "L1920",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 219.54,
      "maximum": 219.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 219.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo spiral molded to pt plas",
  "code_information": [
    {
      "code": "L1950",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 437.48,
      "maximum": 437.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 437.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo spiral prefabricated",
  "code_information": [
    {
      "code": "L1951",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 527.93,
      "maximum": 527.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 527.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo sprng wir drsflx calf bd",
  "code_information": [
    {
      "code": "L1900",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 132.35,
      "maximum": 132.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 132.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo supramalleolar custom",
  "code_information": [
    {
      "code": "L1907",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 353.71,
      "maximum": 353.71,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 353.71,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo tib fx cast molded to pt",
  "code_information": [
    {
      "code": "L2108",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 565.16,
      "maximum": 565.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 565.16,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo tib fx cast plaster mold",
  "code_information": [
    {
      "code": "L2106",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 162.4,
      "maximum": 162.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 162.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo tib fx semi-rigid",
  "code_information": [
    {
      "code": "L2114",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 434.0,
      "maximum": 434.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 434.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo tibial fracture rigid",
  "code_information": [
    {
      "code": "L2116",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 477.58,
      "maximum": 477.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 477.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo tibial fracture soft",
  "code_information": [
    {
      "code": "L2112",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 237.44,
      "maximum": 237.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 237.44,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo w/ankle joint, prefab",
  "code_information": [
    {
      "code": "L1971",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 294.64,
      "maximum": 294.64,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 294.64,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afo, walk boot type, cus fab",
  "code_information": [
    {
      "code": "L4631",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1329.32,
      "maximum": 1329.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1329.32,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Afrin No Drip Sinus Pump Mist",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "11523170201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.01,
      "maximum": 33.36,
      "gross_charge": 33.36,
      "discounted_cash": 18.35,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.91112,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.3416,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.0056,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.352,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.36,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.0056,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12.223104,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.848672,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.71656,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.676,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 20.016,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.692,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.692,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.36,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.1932,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.36,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.016,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.348,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.348,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.344,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.04376,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.94208,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.47744,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.20896,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.539344,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.12488,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.585248,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.220824,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.36,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.543616,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Afstyla factor viii recomb",
  "code_information": [
    {
      "code": "C9140",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.74,
      "maximum": 7.74,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.744246,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AFTER CATARACT LASER SURGERY",
  "code_information": [
    {
      "code": "66821",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 697.05,
      "maximum": 1672.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 697.0512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 697.0512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 943.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1063.01,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 942.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 697.0512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1672.92288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 713.9628,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 707.3885,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 822.520416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 871.314,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 697.0512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 707.3885,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 707.3885,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 697.0512,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AFTERCARE WITH CC/MCC",
  "code_information": [
    {
      "code": "949",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10584.86,
      "maximum": 24582.77,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11846.4,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11846.4,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21825.0465,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24582.7711,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13153.757,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11846.4,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19839.865492,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11846.4,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11846.4,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12490.1348,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13231.075,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10584.86,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11846.4,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10584.86,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AFTERCARE WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "950",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5919.67,
      "maximum": 12970.17,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6475.35,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6475.35,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11515.1565,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12970.1651,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7144.969,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6475.35,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10467.751172,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6475.35,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6475.35,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7399.5875,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6985.2106,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5919.67,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6475.35,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5919.67,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",
  "code_information": [
    {
      "code": "560",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11149.91,
      "maximum": 23268.6,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11238.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11238.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23268.6043,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20658.3045,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13881.5425,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11238.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18779.248996,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11238.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11238.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13156.8938,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13937.3875,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11149.91,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11238.57,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11149.91,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",
  "code_information": [
    {
      "code": "559",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17941.84,
      "maximum": 38534.43,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18299.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18299.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38534.4287,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34211.5905,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22629.589,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18299.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31099.743764,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18299.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18299.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22427.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21171.3712,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17941.84,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18299.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17941.84,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "561",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8110.76,
      "maximum": 16610.99,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8159.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8159.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16610.9857,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14747.5455,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9967.115,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8159.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13406.125804,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8159.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8159.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9570.6968,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10138.45,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8110.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8159.3,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8110.76,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AG DETECTION POLYVAL IF",
  "code_information": [
    {
      "code": "87300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.14,
      "maximum": 28.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.752,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.421013,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.2159,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Agalsidase beta injection",
  "code_information": [
    {
      "code": "J0180",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 211.7,
      "maximum": 596.34,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 230.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 559.151964,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 230.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 223.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 223.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 211.698,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 228.072,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 230.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 228.072,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 552.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 596.3377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 230.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 230.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 263.7536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 279.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 222.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 283.1405,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 230.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 230.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 223.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AGENT NOS ASSAY W/OPTIC",
  "code_information": [
    {
      "code": "87899",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.87,
      "maximum": 38.57,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.568,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.711115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.0945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AGGLUTININS FEBRILE ANTIGEN",
  "code_information": [
    {
      "code": "86000",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.32,
      "maximum": 16.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.752,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.735738,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.0334,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aggrastat 12.5 MG/250 Ml",
  "drug_information": {
    "unit": 12.5,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "25208000202",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 4480.0,
      "gross_charge": 4480.0,
      "discounted_cash": 2464.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1464.96,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 940.8,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3136.0,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4480.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 940.8,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1641.472,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1456.896,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2782.08,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2688.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1568.0,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1111.04,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1111.04,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 4480.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4457.6,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4480.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2688.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2464.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2464.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1792.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1469.44,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1751.68,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1505.28,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1809.92,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 4369.792,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4179.84,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 4241.664,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4058.432,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4480.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3967.488,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aggrastat 3.75 MG/15 Ml Vial",
  "drug_information": {
    "unit": 3.75,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "25208000104",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 2141.0,
      "gross_charge": 2141.0,
      "discounted_cash": 1177.55,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 700.107,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.61,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1498.7,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2141.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.61,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 696.2532,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 784.4624,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 749.35,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1329.561,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1284.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 530.968,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 530.968,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2141.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2130.295,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2141.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1284.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1177.55,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1177.55,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 856.4,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 702.248,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 837.131,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 864.964,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 719.376,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2088.3314,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1997.553,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2027.0988,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1939.5319,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2141.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1896.0696,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Agrylin 0.5 MG Capsule",
  "drug_information": {
    "unit": 0.5,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "54092006301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.11,
      "maximum": 67.21,
      "gross_charge": 67.21,
      "discounted_cash": 36.97,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.02657,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.8351,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.1141,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 47.047,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 67.21,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.1141,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.625744,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.856692,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.5235,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.73741,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 40.326,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.8495,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.8495,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.21,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 66.87395,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.21,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.326,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.9655,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.9655,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.884,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.27911,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.04488,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.58256,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.15284,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 65.556634,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.70693,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.634428,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.885539,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.21,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 59.521176,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AI DS SLE ALYS 10 CYTOKINE",
  "code_information": [
    {
      "code": "0446U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 840.65,
      "maximum": 2017.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2017.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AI DS SLE ALYS 11 CYTOKINE",
  "code_information": [
    {
      "code": "0447U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 840.65,
      "maximum": 2017.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2017.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AI DS SLE ALYS 8 IGG AUTOANT",
  "code_information": [
    {
      "code": "0312U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 840.65,
      "maximum": 2017.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2017.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1292.119374,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1207.5882,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 840.65,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AI IBD MRNA XPRSN PRFL 17",
  "code_information": [
    {
      "code": "0203U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 760.0,
      "maximum": 1824.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 760.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 760.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 760.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1824.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1168.1618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1091.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 760.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 760.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 760.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 760.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AI PSOR MRNA 50-100 GEN ALG",
  "code_information": [
    {
      "code": "0258U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3675.0,
      "maximum": 8820.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3675.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3675.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3675.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8820.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5648.677125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5279.1375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3675.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3675.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3675.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3675.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AI SLE IGG&IGM ALYS 80 BMRK",
  "code_information": [
    {
      "code": "0062U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 380.72,
      "maximum": 913.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 380.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 380.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 380.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 913.728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 585.192309,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 546.9087,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 380.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 380.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 380.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 380.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AICD generator procedures",
  "code_information": [
    {
      "code": "245",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10861.0,
      "maximum": 94272.87,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62077.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44079.38,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to additional per diem in excess of included days",
          "standard_charge_dollar": 10861.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "per diem"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44079.38,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 83697.228,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 94272.8712,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 59573.4835,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44079.38,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 76084.224864,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 31720.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 31720.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 30516.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 47071.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44079.38,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44079.38,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55017.3584,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58281.1,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46624.88,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44079.38,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 67511.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46624.88,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 65546.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 72828.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 64089.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AICD lead procedures",
  "code_information": [
    {
      "code": "265",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10861.0,
      "maximum": 74762.87,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62077.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35055.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to additional per diem in excess of included days",
          "standard_charge_dollar": 10861.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "per diem"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35055.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66375.879,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74762.8666,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43486.649,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35055.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60338.405752,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 30516.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 47071.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35055.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35055.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42668.925,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40279.4652,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34135.14,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35055.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 67511.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34135.14,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 65546.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 72828.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 64089.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AIR DISPLACMNT PLETHYSMOGRAP",
  "code_information": [
    {
      "code": "1002T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.2,
      "maximum": 37.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.5462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Air pressure mattress",
  "code_information": [
    {
      "code": "E0186",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 194.88,
      "maximum": 194.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 194.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Air pressure pad for mattres",
  "code_information": [
    {
      "code": "E0197",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 134.96,
      "maximum": 134.96,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 134.96,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AIRWY RESIST BY OSCILLOMETRY",
  "code_information": [
    {
      "code": "94728",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.62,
      "maximum": 477.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 269.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 303.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.869,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 477.11544,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 167.0331,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 234.581758,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 248.497625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ak 4 bar ling w/hydraul swig",
  "code_information": [
    {
      "code": "L5613",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 862.4,
      "maximum": 862.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 862.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak 4 bar link w/fric swing",
  "code_information": [
    {
      "code": "L5611",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1271.46,
      "maximum": 1271.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1271.46,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak flex inner socket ext fra",
  "code_information": [
    {
      "code": "L5651",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 470.98,
      "maximum": 470.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 470.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak open end sach",
  "code_information": [
    {
      "code": "L5321",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2811.55,
      "maximum": 2811.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2811.55,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak pelvic control belt light",
  "code_information": [
    {
      "code": "L5692",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.65,
      "maximum": 88.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.65,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak pelvic control belt pad/l",
  "code_information": [
    {
      "code": "L5694",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 105.52,
      "maximum": 105.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 105.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak sleeve susp neoprene/equa",
  "code_information": [
    {
      "code": "L5695",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 94.5,
      "maximum": 94.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 94.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak univ multiplex sys frict",
  "code_information": [
    {
      "code": "L5616",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 631.81,
      "maximum": 631.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 631.81,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak/bk self-aligning unit ea",
  "code_information": [
    {
      "code": "L5617",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 244.46,
      "maximum": 244.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 244.46,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak/knee disartic acrylic soc",
  "code_information": [
    {
      "code": "L5631",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 192.5,
      "maximum": 192.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak/knee disartic pelvic band",
  "code_information": [
    {
      "code": "L5697",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 46.45,
      "maximum": 46.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.45,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak/knee disartic pelvic join",
  "code_information": [
    {
      "code": "L5696",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 105.52,
      "maximum": 105.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 105.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ak/knee disartic silesian ba",
  "code_information": [
    {
      "code": "L5698",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 49.14,
      "maximum": 49.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 49.14,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ALANINE AMINO (ALT) (SGPT)",
  "code_information": [
    {
      "code": "84460",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.58,
      "maximum": 12.72,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.158215,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.6245,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.58,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.3,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alatrofloxacin mesylate",
  "code_information": [
    {
      "code": "J0200",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 45.45,
      "maximum": 160.5,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 160.497323,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.4482,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Albendazole 200 MG Tablet",
  "drug_information": {
    "unit": 200.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00591271202",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 1714.0,
      "gross_charge": 1714.0,
      "discounted_cash": 942.7,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 560.478,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.94,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1199.8,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1714.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.94,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 628.0096,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 557.3928,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1064.394,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1028.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 599.9,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 425.072,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 425.072,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1714.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1705.43,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1714.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1028.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 942.7,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 942.7,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 685.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 562.192,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 670.174,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 692.456,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 575.904,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1671.8356,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1599.162,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1622.8152,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1552.7126,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1714.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1517.9184,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Albumin (human), 25%, 20 ml",
  "code_information": [
    {
      "code": "P9046",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.17,
      "maximum": 137.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 137.04705,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.1685,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.952,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.4617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.5375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.0514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.9748,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.23,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Albumin (human), 25%, 50ml",
  "code_information": [
    {
      "code": "P9047",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 53.07,
      "maximum": 380.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 380.68625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 122.7825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 53.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Albumin (human), 5%, 250 ml",
  "code_information": [
    {
      "code": "P9045",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.43,
      "maximum": 391.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 391.650014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.426,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 127.392,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 127.0357,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 62.6344,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 53.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.4434,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.08,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Albumin (human),5%, 50ml",
  "code_information": [
    {
      "code": "P9041",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.61,
      "maximum": 153.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 153.188147,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 89.4787,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.61,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ALBUMIN ISCHEMIA MODIFIED",
  "code_information": [
    {
      "code": "82045",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 30.17,
      "maximum": 81.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 81.456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 52.165282,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.7526,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.94,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alburx (Human) 5% Vial",
  "drug_information": {
    "unit": 25.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "44206031025",
      "type": "NDC"
    },
    {
      "code": "44206031050",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 2596.0,
      "gross_charge": 2596.0,
      "discounted_cash": 1427.8,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 848.892,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 545.16,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1817.2,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2596.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 545.16,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 844.2192,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 951.1744,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1612.116,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1557.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 908.6,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 643.808,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 643.808,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2596.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2583.02,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2596.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1557.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1427.8,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1427.8,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1038.4,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1015.036,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 851.488,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1048.784,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 872.256,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2532.1384,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2422.068,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2457.8928,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2351.7164,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2596.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2299.0176,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    },
    {
      "minimum": 0.47,
      "maximum": 1186.0,
      "gross_charge": 1186.0,
      "discounted_cash": 652.3,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 387.822,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 249.06,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 830.2,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1186.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 249.06,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 434.5504,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 385.6872,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 415.1,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 736.506,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 711.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 294.128,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 294.128,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1186.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1180.07,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1186.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 711.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 652.3,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 652.3,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 474.4,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 463.726,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 389.008,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 479.144,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 398.496,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1156.8244,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1106.538,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1122.9048,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1074.3974,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1186.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1050.3216,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Albuterol 2.5 MG/0.5 Ml Sol",
  "drug_information": {
    "unit": 2.5,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00487990130",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.53,
      "maximum": 26.34,
      "gross_charge": 26.34,
      "discounted_cash": 14.49,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.98378,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.1654,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.5314,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.438,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.34,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.5314,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.650976,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.565768,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.35714,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 15.804,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.219,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.023,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.023,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.34,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.2083,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.34,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.804,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.487,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.487,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.536,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.29894,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.63952,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.64136,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.85024,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 25.692036,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.57522,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.938712,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.861406,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.34,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.326704,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Albuterol comp con",
  "code_information": [
    {
      "code": "J7610",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.29,
      "maximum": 8.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.527372,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.2902,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Albuterol comp unit",
  "code_information": [
    {
      "code": "J7609",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.61,
      "maximum": 1.36,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 0.609098,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.3642,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Albuterol Hfa 90 Mcg Inhaler",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00054074287",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.01,
      "maximum": 4.81,
      "gross_charge": 4.81,
      "discounted_cash": 2.65,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.00577,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.4911,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.0101,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.367,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.81,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.0101,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.762384,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.564212,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.6835,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.98701,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2.886,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.5695,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.5695,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.81,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.78595,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.81,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.886,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.6455,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.6455,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.924,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.88071,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.57768,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.94324,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.61616,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.691674,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.48773,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.554108,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.357379,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.81,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.259736,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Albuterol ipratrop non-comp",
  "code_information": [
    {
      "code": "J7620",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.41,
      "maximum": 17.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.054744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.408,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.408,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 0.5082,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Albuterol non-comp con",
  "code_information": [
    {
      "code": "J7611",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.12,
      "maximum": 0.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 0.609098,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.357,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.357,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 0.4547,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 0.12,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Albuterol non-comp unit",
  "code_information": [
    {
      "code": "J7613",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.04,
      "maximum": 1.83,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.827294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.5355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.5355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 0.1337,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 0.04,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Albuterol Sul 1.25 MG/3 Ml Sol",
  "drug_information": {
    "unit": 1.25,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00487990401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.22,
      "maximum": 43.9,
      "gross_charge": 43.9,
      "discounted_cash": 24.15,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.3063,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.609,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.219,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.73,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43.9,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.219,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.27628,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.08496,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.2619,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 26.34,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.365,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.705,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.705,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.9,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.6805,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.9,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.34,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.145,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.145,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.56,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.1649,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.3992,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.7504,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.7356,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 42.82006,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 40.9587,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 41.56452,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 39.76901,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.9,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 38.87784,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Albuterol Sul 2.5 MG/3 Ml Soln",
  "drug_information": {
    "unit": 2.5,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00487950101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.07,
      "maximum": 71.77,
      "gross_charge": 71.77,
      "discounted_cash": 39.47,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.92809,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.2487,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.0717,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.239,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 71.77,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.0717,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.296528,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.339604,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.1195,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.56917,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 43.062,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 68.1815,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 68.1815,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 71.77,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 71.41115,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 71.77,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.062,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.4735,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39.4735,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.708,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.06207,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.54056,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.99508,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.11472,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 70.004458,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 66.96141,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.951836,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 65.016443,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 71.77,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 63.559512,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Albuterol Sulfate ER 4 MG Tab",
  "drug_information": {
    "unit": 4.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00378412201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.14,
      "maximum": 24.49,
      "gross_charge": 24.49,
      "discounted_cash": 13.47,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.21233,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.5919,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.1429,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.143,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.49,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.1429,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.964148,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.973136,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.5715,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.20829,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 14.694,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.2655,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.2655,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.49,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.36755,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.49,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.694,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.4695,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.4695,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.796,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.57559,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.03272,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.89396,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.22864,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.887546,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.84917,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.187132,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.185491,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.49,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.688344,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alcohol Dehydrated 98% Ampule",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "44827030301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 40.53,
      "maximum": 193.0,
      "gross_charge": 193.0,
      "discounted_cash": 106.15,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.481,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.83,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.53,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 135.1,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 193.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.53,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 70.7152,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 62.7636,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.55,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 119.853,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 115.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 183.35,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 183.35,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 193.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 192.035,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 193.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 106.15,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 106.15,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.463,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.304,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.972,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.848,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 188.2522,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 180.069,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 182.7324,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 174.8387,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 193.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 170.9208,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alcohol/drug abuse or dependence w rehabilitation therapy",
  "code_information": [
    {
      "code": "895",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14005.33,
      "maximum": 29250.54,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25969.182,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29250.5428,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23607.055216,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC",
  "code_information": [
    {
      "code": "896",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17154.37,
      "maximum": 36059.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36059.0013,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32013.8595,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29101.915836,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC",
  "code_information": [
    {
      "code": "897",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8722.19,
      "maximum": 18241.3,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16194.966,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18241.2964,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14721.890608,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alcohol/drug abuse or dependence, left AMA",
  "code_information": [
    {
      "code": "894",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6279.33,
      "maximum": 12747.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12747.0047,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11317.0305,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10287.646484,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alcohol/sub misuse assess",
  "code_information": [
    {
      "code": "G2011",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.81,
      "maximum": 74.68,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 42.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.0945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.6808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.5462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.89625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.71806,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alcohol/subs interv >30 min",
  "code_information": [
    {
      "code": "G0397",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 60.61,
      "maximum": 489.95,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 311.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 276.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 276.1175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 489.95352,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 230.4106,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 228.2889,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 240.893814,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.184125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 60.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 228.2889,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 228.2889,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.1473,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alcohol/subs interv 15-30mn",
  "code_information": [
    {
      "code": "G0396",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 31.24,
      "maximum": 90.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.1955,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.84288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.6386,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.314,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.664416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aldactone 25 MG Tablet",
  "drug_information": {
    "unit": 25.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00025100131",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.29,
      "maximum": 58.51,
      "gross_charge": 58.51,
      "discounted_cash": 32.18,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.39867,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.1381,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.2871,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.957,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.2871,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 19.027452,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.438064,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.4785,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.33471,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 35.106,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.5845,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.5845,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.21745,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.106,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.1805,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.1805,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.404,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.87741,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.19128,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.63804,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.65936,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.070654,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 54.58983,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 55.397268,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.004209,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.816456,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aldesleukin injection",
  "code_information": [
    {
      "code": "J9015",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3064.07,
      "maximum": 15147.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5301.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3064.067489,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5301.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5301.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5301.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5036.197,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6181.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5301.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6181.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12723.024,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15147.1875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3338.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3338.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6255.4868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6626.575,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5555.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6735.781,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3338.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3338.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5301.26,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALDOSTERONE SUPPRESSION EVAL",
  "code_information": [
    {
      "code": "80408",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 125.5,
      "maximum": 301.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 125.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 125.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 125.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 192.912226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 180.2918,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 125.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 125.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 125.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 125.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 125.5,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alefacept",
  "code_information": [
    {
      "code": "J0215",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 111.39,
      "maximum": 183.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 183.033949,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 111.387,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Alemtuzumab injection",
  "code_information": [
    {
      "code": "J9010",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2210.42,
      "maximum": 2210.42,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2210.416642,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Alexiguard dl-t per sq cm",
  "code_information": [
    {
      "code": "Q4417",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alexiguard st-l per sq cm",
  "code_information": [
    {
      "code": "Q4415",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alexiguard tl-t per sq cm",
  "code_information": [
    {
      "code": "Q4416",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alfentanil 500 Mcg/Ml Ampule",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "17478006702",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 119.0,
      "gross_charge": 119.0,
      "discounted_cash": 65.45,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 38.913,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.99,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 83.3,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 119.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.99,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.6016,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 38.6988,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.899,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 71.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.65,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.512,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.512,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 119.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 118.405,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 119.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 65.45,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 65.45,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.032,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.529,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.076,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.984,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 116.0726,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 111.027,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 112.6692,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 107.8021,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 119.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 105.3864,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alglucerase injection",
  "code_information": [
    {
      "code": "J0205",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 112.43,
      "maximum": 154.71,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 154.710892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 112.4302,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Alglucosidase alfa injection",
  "code_information": [
    {
      "code": "J0220",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 198.9,
      "maximum": 587.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 587.475021,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 198.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 198.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 552.9225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 211.1,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Alimta 500 MG Vial",
  "drug_information": {
    "unit": 500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00002762301",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 2131.55,
      "gross_charge": 2131.55,
      "discounted_cash": 1172.35,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 697.01685,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 190.952223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2131.55,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.3105,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1323.69255,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.3105,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 528.6244,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 528.6244,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2131.55,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2120.89225,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2131.55,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.9324,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.7902,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 833.43605,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 699.1484,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 716.2008,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 861.1462,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2079.11387,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1988.73615,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2018.15154,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1930.971145,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2131.55,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1887.70068,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alinia 500 MG Tablet",
  "drug_information": {
    "unit": 500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "67546011112",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.4,
      "maximum": 240.0,
      "gross_charge": 240.0,
      "discounted_cash": 132.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.08,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.4,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.4,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 168.0,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 240.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.4,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 78.048,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 87.936,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 84.0,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 149.04,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 144.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 228.0,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 228.0,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 240.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 238.8,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 240.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 144.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 96.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.84,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 78.72,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 96.96,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.64,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 234.096,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 223.92,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 227.232,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 217.416,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 240.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 212.544,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aliskiren 150 MG Tablet",
  "drug_information": {
    "unit": 150.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "49884042411",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.8,
      "maximum": 56.2,
      "gross_charge": 56.2,
      "discounted_cash": 30.91,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.4354,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.422,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.802,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.34,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 56.2,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.802,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 20.59168,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 18.27624,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.9002,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 33.72,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.67,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 53.39,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 53.39,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 56.2,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 55.919,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 56.2,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.72,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.91,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.91,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.48,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.9742,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.4336,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.7048,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.8832,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 54.81748,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 52.4346,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.21016,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 50.91158,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 56.2,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 49.77072,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alkeran 2 MG Tablet",
  "drug_information": {
    "unit": 2.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "52609000105",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 91.59,
      "gross_charge": 91.59,
      "discounted_cash": 50.37,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 29.94993,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.2339,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.404783,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 91.59,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.2339,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.785068,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.558576,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.3415,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 56.87739,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.3415,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.0565,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.71432,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.71432,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.59,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.13205,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.59,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 54.954,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.3745,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50.3745,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.636,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.81169,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.04152,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.00236,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.77424,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.336886,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 85.45347,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 86.717412,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 82.971381,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.59,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 81.112104,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALL TSTG PERQ&IQ DRUGS/BIOL",
  "code_information": [
    {
      "code": "95018",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.39,
      "maximum": 119.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.4595,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 119.69064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.4861,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 62.338875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.847898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALL TSTG PERQ&IQ W/VENOMS",
  "code_information": [
    {
      "code": "95017",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.75,
      "maximum": 74.68,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 42.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.0945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.6808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.5462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.89625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.71806,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Allegra Allergy 60 MG Tablet",
  "drug_information": {
    "unit": 60.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "41167041312",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.08,
      "maximum": 76.58,
      "gross_charge": 76.58,
      "discounted_cash": 42.12,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.93386,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.7398,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.0818,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 53.606,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.58,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.0818,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 28.058912,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.903816,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.803,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 47.55618,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 45.948,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72.751,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72.751,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.58,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.1971,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.58,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.948,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.119,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.119,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.632,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.94278,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.11824,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.93832,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.73088,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.696132,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 71.44914,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 72.505944,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 69.373822,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.58,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.819248,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ALLERGEN SPECIFIC IGG",
  "code_information": [
    {
      "code": "86001",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.68,
      "maximum": 18.77,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.768,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.012676,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.2268,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.82,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALLERGIC REACTIONS WITH MCC",
  "code_information": [
    {
      "code": "915",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16547.5,
      "maximum": 34746.9,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16547.5,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16547.5,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30848.952,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34746.9008,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21186.2065,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16547.5,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28042.966976,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16547.5,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16547.5,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21026.5125,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19849.0278,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16821.21,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16547.5,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16821.21,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALLERGIC REACTIONS WITHOUT MCC",
  "code_information": [
    {
      "code": "916",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6657.92,
      "maximum": 13767.76,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13767.7569,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12223.2735,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8095.843,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11111.458668,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7856.3456,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8322.4,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6657.92,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6657.92,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALLG SPEC IGE CRUDE XTRC EA",
  "code_information": [
    {
      "code": "86003",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.64,
      "maximum": 12.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.22,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.22,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.22,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.528,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.016333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.4919,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.22,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.22,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.22,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.22,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALLG SPEC IGE MULTIALLG SCR",
  "code_information": [
    {
      "code": "86005",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.97,
      "maximum": 19.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.128,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.249146,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.4478,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALLG SPEC IGE RECOMB EA",
  "code_information": [
    {
      "code": "86008",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.94,
      "maximum": 43.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43.032,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.548755,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.7465,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALLGRFT IMPLNT KNEE W/SCOPE",
  "code_information": [
    {
      "code": "29867",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alloderm",
  "code_information": [
    {
      "code": "Q4116",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.78,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 83.2192,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ALLOGENEIC BONE MARROW TRANSPLANT",
  "code_information": [
    {
      "code": "014",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 115331.79,
      "maximum": 248325.87,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115331.79,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115331.79,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 220468.3755,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 248325.8677,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 159720.042,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115331.79,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200414.826844,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115331.79,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115331.79,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 146766.158,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 155472.625,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 124378.1,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 115331.79,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 124378.1,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alloply, per sq cm",
  "code_information": [
    {
      "code": "Q4323",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Allopurinol 300 MG Tablet",
  "drug_information": {
    "unit": 300.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00378018101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.29,
      "maximum": 58.51,
      "gross_charge": 58.51,
      "discounted_cash": 32.18,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.39867,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.1381,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.2871,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.957,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.2871,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 19.027452,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.438064,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.33471,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.4785,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 35.106,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.5845,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.5845,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.21745,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.106,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.1805,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.1805,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.404,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.87741,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.19128,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.63804,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.65936,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.070654,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 54.58983,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 55.397268,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.004209,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.816456,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alloskin",
  "code_information": [
    {
      "code": "Q4123",
      "type": "HCPCS"
    },
    {
      "code": "Q4115",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 23.4,
      "maximum": 407.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 407.921632,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.5695,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 236.8712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Alloskin ac, 1 cm",
  "code_information": [
    {
      "code": "Q4141",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 114.33,
      "maximum": 438.86,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 438.855109,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 114.3295,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Allowrap ds or dry 1 sq cm",
  "code_information": [
    {
      "code": "Q4150",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 211.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 211.325,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ALPHA-1-ANTITRYPSIN PHENO",
  "code_information": [
    {
      "code": "82104",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.86,
      "maximum": 34.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.22818,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.774,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.46,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALPHA-1-ANTITRYPSIN TOTAL",
  "code_information": [
    {
      "code": "82103",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.94,
      "maximum": 32.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.256,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.667478,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.3154,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.44,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALPHA-FETOPROTEIN AMNIOTIC",
  "code_information": [
    {
      "code": "82106",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.03,
      "maximum": 40.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.129935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.4205,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.03,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALPHA-FETOPROTEIN L3",
  "code_information": [
    {
      "code": "82107",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 57.26,
      "maximum": 154.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 154.584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.009989,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 92.5327,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.41,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALPHA-FETOPROTEIN SERUM",
  "code_information": [
    {
      "code": "82105",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.77,
      "maximum": 85.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.248,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.77523,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.089,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 85.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.77,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alphanate 1 500-600 Unit Vial",
  "drug_information": {
    "unit": 1500.0,
    "type": "UN"
  },
  "code_information": [
    {
      "code": "68516460402",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 9418.5,
      "gross_charge": 9418.5,
      "discounted_cash": 5180.18,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 3079.8495,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.481882,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9418.5,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold",
          "standard_charge_dollar": 3710.889,
          "standard_charge_percentage": 39.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2335.788,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2335.788,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 4775.1795,
          "standard_charge_percentage": 50.7,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to lesser of provisions",
          "standard_charge_dollar": 5782.959,
          "standard_charge_percentage": 61.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.5375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.4514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3767.4,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.5247,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3682.6335,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3089.268,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3805.074,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3164.616,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3741.0282,
          "standard_charge_percentage": 39.72,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3631.7736,
          "standard_charge_percentage": 38.56,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to lesser of provisions",
          "standard_charge_dollar": 4035.82725,
          "standard_charge_percentage": 42.85,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to lesser of provisions",
          "standard_charge_dollar": 3550.7745,
          "standard_charge_percentage": 37.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alprostadil 500 Mcg/Ml Vial",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00703150102",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.39,
      "maximum": 995.0,
      "gross_charge": 995.0,
      "discounted_cash": 547.25,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 325.365,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.95,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 59.387055,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 995.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 208.95,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 323.574,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 364.568,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.391,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 348.25,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 617.895,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.391,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 246.76,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 246.76,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 995.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 990.025,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 995.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 597.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 547.25,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 547.25,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 398.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 389.045,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 326.36,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 401.98,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 334.32,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 970.523,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 928.335,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 942.066,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 901.3705,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 995.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 881.172,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Alprostadil urethral suppos",
  "code_information": [
    {
      "code": "J0275",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 68.8,
      "maximum": 86.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 86.187367,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.749,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 74.749,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 68.801,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Als 1",
  "code_information": [
    {
      "code": "A0426",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 107.16,
      "maximum": 107.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 107.16,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Als 2",
  "code_information": [
    {
      "code": "A0433",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 118.2,
      "maximum": 118.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 118.2,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Als1-emergency",
  "code_information": [
    {
      "code": "A0427",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 118.2,
      "maximum": 118.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 118.2,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ALT ELEC FLD DOS&DLV SIM MDL",
  "code_information": [
    {
      "code": "1025T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 172.87,
      "maximum": 174.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 174.4788,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.8721,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.8721,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.8721,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alteplase recombinant",
  "code_information": [
    {
      "code": "J2997",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 86.89,
      "maximum": 244.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 147.097167,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 86.887,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.0975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.0975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 226.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 244.3345,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 93.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 93.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 107.9346,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 114.3375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.2091,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 93.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 93.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 91.47,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alternating pressure pad",
  "code_information": [
    {
      "code": "A4640",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 45.18,
      "maximum": 45.18,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.18,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Altuviiio per factor viii iu",
  "code_information": [
    {
      "code": "J7214",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.37,
      "maximum": 24.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.66,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.059371,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.66,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.576,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.576,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.66,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.184,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.5725,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.5342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.8625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.8448,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.69,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALVEOLOPLASTY EACH QUADRANT",
  "code_information": [
    {
      "code": "41874",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4120.64,
      "maximum": 9889.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5578.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6283.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5573.232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9889.54728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4303.8653,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4264.2342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5150.805875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4862.360746,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4264.2342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4264.2342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alveoloplasty not w/extracts",
  "code_information": [
    {
      "code": "D7321",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1882.11,
      "maximum": 4517.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2870.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2548.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2545.601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4517.07456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2014.1424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2220.894992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2352.643,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alveoloplasty w/extract 1-3",
  "code_information": [
    {
      "code": "D7311",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1882.11,
      "maximum": 4517.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2548.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2870.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2545.601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4517.07456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2014.1424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2352.643,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2220.894992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alveolus clsd reduc stblz te",
  "code_information": [
    {
      "code": "D7771",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4120.64,
      "maximum": 9889.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6283.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5578.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5573.232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9889.54728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4303.8653,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4264.2342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4862.360746,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5150.805875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4264.2342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4264.2342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alveolus open reduction",
  "code_information": [
    {
      "code": "D7671",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7516.44,
      "maximum": 18039.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7516.4376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7516.4376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10176.21,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11462.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10166.102,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7516.4376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18039.45024,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7684.6523,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7613.8901,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8869.396368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9395.547,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7516.4376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7613.8901,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7613.8901,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7516.4376,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alveoplasty w/ extraction",
  "code_information": [
    {
      "code": "D7310",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1882.11,
      "maximum": 4517.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2548.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2870.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2545.601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4517.07456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2014.1424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2220.894992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2352.643,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Alveoplasty w/o extraction",
  "code_information": [
    {
      "code": "D7320",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1882.11,
      "maximum": 4517.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2548.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2870.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2545.601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4517.07456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2014.1424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2220.894992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2352.643,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALYS BRN NPGT PRGRMG 15 MIN",
  "code_information": [
    {
      "code": "95983",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 43.92,
      "maximum": 279.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 157.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 177.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 157.738,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 279.90816,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 123.4134,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.621512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 145.7855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALYS BRN NPGT PRGRMG ADDL 15",
  "code_information": [
    {
      "code": "95984",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 38.29,
      "maximum": 38.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38.29,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ALYS CPLX CN NPGT PRGRMG",
  "code_information": [
    {
      "code": "95977",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 46.54,
      "maximum": 279.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 157.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 177.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 157.738,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 279.90816,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 123.4134,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.621512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 145.7855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALYS CPLX SP/PN NPGT W/PRGRM",
  "code_information": [
    {
      "code": "95972",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 64.73,
      "maximum": 279.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 177.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 157.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 157.738,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 279.90816,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 123.4134,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 145.7855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.621512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALYS NPGT W/O PRGRMG",
  "code_information": [
    {
      "code": "95970",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.79,
      "maximum": 393.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 249.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.521,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 393.07272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 193.260754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.725375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALYS SMPL CN NPGT PRGRMG",
  "code_information": [
    {
      "code": "95976",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 35.02,
      "maximum": 113.71,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.3807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.3807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 72.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 64.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.087,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.3807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 113.71368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.448,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0019,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.909226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 59.225875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.02,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.3807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0019,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0019,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.3807,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ALYS SMPL SP/PN NPGT W/PRGRM",
  "code_information": [
    {
      "code": "95971",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 33.72,
      "maximum": 279.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 157.9,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 177.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 157.738,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 279.90816,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 123.4134,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.621512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 145.7855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 116.6284,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Am bur mem hydro per sq cm",
  "code_information": [
    {
      "code": "Q4363",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Am bur xp mem xpl hy p sq cm",
  "code_information": [
    {
      "code": "Q4364",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amalgam 4 or > surfaces perm",
  "code_information": [
    {
      "code": "D2161",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amalgam one surface permanen",
  "code_information": [
    {
      "code": "D2140",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amalgam three surfaces perma",
  "code_information": [
    {
      "code": "D2160",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amalgam two surfaces permane",
  "code_information": [
    {
      "code": "D2150",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amantadine 100 MG Capsule",
  "drug_information": {
    "unit": 100.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00904704206",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.31,
      "maximum": 15.74,
      "gross_charge": 15.74,
      "discounted_cash": 8.66,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.56358,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.8794,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.3054,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.018,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.74,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.3054,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.118648,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.767136,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.77454,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.509,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 9.444,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.953,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.953,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.74,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.6613,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.74,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.444,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.657,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.657,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.296,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.15434,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.16272,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.35896,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.28864,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.352796,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.68542,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.902632,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.258866,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.74,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.939344,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amantadine hcl 100mg oral",
  "code_information": [
    {
      "code": "G9017",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.96,
      "maximum": 2.96,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.958476,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amb infusion pump mechanical",
  "code_information": [
    {
      "code": "E0779",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 153.88,
      "maximum": 153.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 153.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ambien 5 MG Tablet",
  "drug_information": {
    "unit": 5.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00024540131",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.94,
      "maximum": 52.08,
      "gross_charge": 52.08,
      "discounted_cash": 28.64,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.71736,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.1448,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.9368,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.456,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 52.08,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.9368,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.936416,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 19.082112,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.228,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.34168,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 31.248,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 49.476,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 49.476,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 52.08,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.8196,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 52.08,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.248,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.644,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.644,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.832,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.08224,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.36328,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.04032,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.49888,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 50.798832,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 48.59064,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 49.309344,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.179272,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 52.08,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 46.122048,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Ambisome 50 MG Vial",
  "drug_information": {
    "unit": 50.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00469305130",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 1964.0,
      "gross_charge": 1964.0,
      "discounted_cash": 1080.2,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 642.228,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 412.44,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1374.8,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1964.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 412.44,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 719.6096,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 638.6928,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 687.4,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1219.644,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1178.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 487.072,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 487.072,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1964.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1954.18,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1964.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1178.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1080.2,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1080.2,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 785.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 767.924,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 644.192,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 793.456,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 659.904,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1915.6856,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1832.412,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1859.5152,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1779.1876,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1964.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1739.3184,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMBL BP MNTR W/SOFTWARE",
  "code_information": [
    {
      "code": "93784",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 48.4,
      "maximum": 48.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AMBL BP MNTR W/SW A/R",
  "code_information": [
    {
      "code": "93788",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.81,
      "maximum": 393.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 249.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.521,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 393.07272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 193.260754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.725375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMBL BP MNTR W/SW I&R",
  "code_information": [
    {
      "code": "93790",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.15,
      "maximum": 16.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AMBL BP MNTR W/SW REC ONLY",
  "code_information": [
    {
      "code": "93786",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.39,
      "maximum": 393.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 249.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.521,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 393.07272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 193.260754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.725375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ambulance 02 life sustaining",
  "code_information": [
    {
      "code": "A0422",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.98,
      "maximum": 9.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ambulance waiting 1/2 hr",
  "code_information": [
    {
      "code": "A0420",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.76,
      "maximum": 19.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.76,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ambulatory surgical boot eac",
  "code_information": [
    {
      "code": "L3260",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 76.53,
      "maximum": 76.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.53,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amchomatrixdl per sq cm",
  "code_information": [
    {
      "code": "Q4410",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amchoplast excl per sq cm",
  "code_information": [
    {
      "code": "Q4372",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amchoplast fd per sq cm",
  "code_information": [
    {
      "code": "Q4360",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amchoplast, per sq cm",
  "code_information": [
    {
      "code": "Q4316",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amchothick per sq cm",
  "code_information": [
    {
      "code": "Q4368",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amer am ac tri-lay per sq cm",
  "code_information": [
    {
      "code": "Q4305",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Americ amnion ac per sq cm",
  "code_information": [
    {
      "code": "Q4306",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "American amnion, per sq cm",
  "code_information": [
    {
      "code": "Q4307",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amicar 500 MG Tablet",
  "drug_information": {
    "unit": 500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "49411005030",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.98,
      "maximum": 80.84,
      "gross_charge": 80.84,
      "discounted_cash": 44.46,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.71028,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.0604,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.9764,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 56.588,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.84,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.9764,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.289168,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.619776,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.20164,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 48.504,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.294,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.798,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 76.798,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 80.84,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 80.4358,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 80.84,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.504,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.462,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.462,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.336,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.60844,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.51552,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.65936,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.16224,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 78.851336,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 75.42372,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.539312,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 73.232956,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 80.84,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 71.591904,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amifostine",
  "code_information": [
    {
      "code": "J0207",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1075.87,
      "maximum": 2923.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1616.241543,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1092.8365,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1092.8365,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2923.347,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1075.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amikacin Sulf 1 Gram/4 Ml Vial",
  "drug_information": {
    "unit": 250.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00641616601",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 819.0,
      "gross_charge": 819.0,
      "discounted_cash": 450.45,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 267.813,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.99,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 573.3,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 819.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.99,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 266.3388,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 300.0816,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 286.65,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 508.599,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 491.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 203.112,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 203.112,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 819.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 814.905,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 819.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 491.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 450.45,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 450.45,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 327.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 320.229,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 268.632,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 330.876,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 275.184,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 798.8526,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 764.127,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 775.4292,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 741.9321,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 819.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 725.3064,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amikacin sulfate injection",
  "code_information": [
    {
      "code": "J0278",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.53,
      "maximum": 28.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.018508,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.1132,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.4,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amiloride HCl 5 MG Tablet",
  "drug_information": {
    "unit": 5.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "49884011701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.99,
      "maximum": 14.22,
      "gross_charge": 14.22,
      "discounted_cash": 7.82,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.92974,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.4082,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.9862,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.954,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.22,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.9862,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.210208,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.624344,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.83062,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 8.532,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.977,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.509,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.509,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.22,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.1489,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.22,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.532,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.821,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.821,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.688,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.56002,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.66416,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.74488,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.77792,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.870188,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.26726,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.463496,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12.881898,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.22,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12.593232,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMINES VAGINAL FLUID QUAL",
  "code_information": [
    {
      "code": "82120",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.01,
      "maximum": 14.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.198683,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.5969,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.01,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.99,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMINO ACID SINGLE QUAL",
  "code_information": [
    {
      "code": "82127",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.33,
      "maximum": 34.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.032,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.802534,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.3762,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.18,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMINO ACIDS MULT QUAL",
  "code_information": [
    {
      "code": "82128",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.33,
      "maximum": 33.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.329594,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.9342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMINO ACIDS QUAN 6 OR MORE",
  "code_information": [
    {
      "code": "82139",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.99,
      "maximum": 40.49,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.940759,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.2437,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMINO ACIDS QUANT 2-5",
  "code_information": [
    {
      "code": "82136",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.69,
      "maximum": 47.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.149925,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.1775,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.69,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.61,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMINO ACIDS SINGLE QUANT",
  "code_information": [
    {
      "code": "82131",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 18.36,
      "maximum": 55.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.152,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.328618,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.0174,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aminocaproic Acid 5 G/20 Ml Vl",
  "drug_information": {
    "unit": 5.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "00409434673",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 680.0,
      "gross_charge": 680.0,
      "discounted_cash": 374.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 222.36,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.8,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 476.0,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 680.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.8,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 249.152,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.136,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 422.28,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 408.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 238.0,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 168.64,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 168.64,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 680.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 676.6,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 680.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 408.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 374.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 374.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 272.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 265.88,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 223.04,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 274.72,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 228.48,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 663.272,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 634.44,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 643.824,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 616.012,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 680.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 602.208,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aminolevulinic acid hcl top",
  "code_information": [
    {
      "code": "J7308",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 374.69,
      "maximum": 1057.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 392.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 462.305382,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 392.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 395.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 395.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 374.6895,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 392.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 401.081,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 401.081,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 941.016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1057.267,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 389.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 389.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 496.2125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 468.4246,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 501.1373,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 389.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 389.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 396.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aminolevulinic acid, 10% gel",
  "code_information": [
    {
      "code": "J7345",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.66,
      "maximum": 6.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.395529,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.691,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.296,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.6545,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.0296,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.66,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.2617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aminophyllin 250 mg inj",
  "code_information": [
    {
      "code": "J0280",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.44,
      "maximum": 35.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.441019,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.481,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.481,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.2565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Aminophylline 250 MG/10 Ml Vl",
  "drug_information": {
    "unit": 250.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00409592101",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 89.81,
      "gross_charge": 89.81,
      "discounted_cash": 49.4,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 29.36787,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.8601,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 62.867,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 89.81,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.8601,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.906384,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.206212,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.4335,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.77201,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 53.886,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.27288,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.27288,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.81,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.36095,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.81,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53.886,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.3955,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.3955,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.924,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.11571,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.45768,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.28324,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.17616,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 87.600674,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 83.79273,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 85.032108,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 81.358879,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.81,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 79.535736,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aminosyn II 8.5% IV Solution",
  "drug_information": {
    "unit": 500.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00409416203",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 340.83,
      "maximum": 1623.0,
      "gross_charge": 1623.0,
      "discounted_cash": 892.65,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 676.791,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 503.13,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 340.83,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1136.1,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1623.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 340.83,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 594.6672,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 527.7996,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 568.05,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1007.883,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 973.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1541.85,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1541.85,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1623.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1614.885,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1623.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 973.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 892.65,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 892.65,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 649.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 634.593,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 532.344,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 655.692,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 545.328,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1583.0742,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1514.259,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1536.6564,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1470.2757,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1623.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1437.3288,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aminosyn-Pf 10% IV Solution",
  "drug_information": {
    "unit": 500.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00990417905",
      "type": "NDC"
    },
    {
      "code": "00990417905_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 506.94,
      "maximum": 2414.0,
      "gross_charge": 2414.0,
      "discounted_cash": 1327.7,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1006.638,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 748.34,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 506.94,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1689.8,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2414.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 506.94,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 785.0328,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 884.4896,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 844.9,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1499.094,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1448.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2293.3,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2293.3,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2414.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2401.93,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2414.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1448.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1327.7,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1327.7,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 965.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 943.874,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 791.792,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 975.256,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 811.104,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2354.6156,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2252.262,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2285.5752,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2186.8426,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2414.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2137.8384,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amiodarone 150 MG/3 Ml Vial",
  "drug_information": {
    "unit": 150.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "55150018003",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 31.81,
      "gross_charge": 31.81,
      "discounted_cash": 17.5,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 10.40187,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.6801,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.267,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.81,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.6801,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.344612,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.655184,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.75401,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 19.086,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.1335,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.88888,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.88888,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.81,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.65095,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.81,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.086,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.4955,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.4955,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.724,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.43771,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.43368,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.85124,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.68816,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.027474,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.67873,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.117708,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 28.816679,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.81,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 28.170936,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amiodarone 450 MG/9 Ml Vial",
  "drug_information": {
    "unit": 450.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "63323061609",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 23.91,
      "gross_charge": 23.91,
      "discounted_cash": 13.15,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 7.81857,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.0211,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.737,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.91,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.0211,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.760624,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.775532,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.84811,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 14.346,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.3685,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.92968,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.92968,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.91,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.79045,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.91,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.346,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.1505,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.1505,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.564,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.34881,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.84248,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.65964,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.03376,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.321814,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.30803,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.637988,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.660069,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.91,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.174696,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amiodarone hcl",
  "code_information": [
    {
      "code": "J0282",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.48,
      "maximum": 129.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 129.128776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.3642,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amiodarone HCl 100 MG Tablet",
  "drug_information": {
    "unit": 100.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "51672405506",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.57,
      "maximum": 31.3,
      "gross_charge": 31.3,
      "discounted_cash": 17.22,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.0521,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.703,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.573,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.91,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.3,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.573,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.46832,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.17876,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.955,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.4373,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 18.78,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.735,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.735,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.3,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.1435,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.3,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.78,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.215,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.215,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.52,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.2664,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.2383,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.6452,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.5168,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.53002,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.2029,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.63484,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 28.35467,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31.3,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.71928,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amitriptyline HCl 10 MG Tab",
  "drug_information": {
    "unit": 10.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "70710122501",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.77,
      "maximum": 60.8,
      "gross_charge": 60.8,
      "discounted_cash": 33.44,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.3536,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.848,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.768,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.56,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 60.8,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.768,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 19.77216,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.27712,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.7568,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 36.48,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.28,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.76,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.76,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.8,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.496,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.8,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.48,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.44,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.44,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.32,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.7728,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.9424,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.5632,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.4288,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 59.30432,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 56.7264,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.56544,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 55.07872,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.8,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.84448,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amitriptyline HCl 100 MG Tab",
  "drug_information": {
    "unit": 100.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00378268501",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.34,
      "maximum": 11.13,
      "gross_charge": 11.13,
      "discounted_cash": 6.12,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.64121,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.4503,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.3373,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.791,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.13,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.3373,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.078032,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.619476,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.8955,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 6.678,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.91173,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.5735,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.5735,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.13,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.07435,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.13,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.678,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.1215,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.1215,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.452,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.35183,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.65064,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.49652,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.73968,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.856202,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.38429,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.537884,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.082667,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.13,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.856728,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amitriptyline HCl 25 MG Tab",
  "drug_information": {
    "unit": 25.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00378262501",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.77,
      "maximum": 60.8,
      "gross_charge": 60.8,
      "discounted_cash": 33.44,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.3536,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.848,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.768,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.56,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 60.8,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.768,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 19.77216,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.27712,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.7568,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 36.48,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.28,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.76,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.76,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.8,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.496,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.8,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.48,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.44,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33.44,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.32,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.7728,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.9424,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.5632,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.4288,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 59.30432,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 56.7264,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.56544,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 55.07872,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.8,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.84448,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amitriptyline injection",
  "code_information": [
    {
      "code": "J1320",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.99,
      "maximum": 37.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.154978,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.992,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ammonia Inhalant Ampule",
  "drug_information": {
    "unit": 0.33,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "39822990002",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.64,
      "maximum": 50.67,
      "gross_charge": 50.67,
      "discounted_cash": 27.87,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.12939,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.7077,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.6407,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.469,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.67,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.6407,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 18.565488,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 16.477884,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.7345,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.46607,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 30.402,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.1365,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.1365,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 50.67,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 50.41665,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 50.67,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30.402,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.8685,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.8685,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.268,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.81197,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.61976,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.47068,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.02512,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 49.423518,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.27511,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.974356,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 45.901953,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 50.67,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 44.873352,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Ammonium Lactate 12% Lotion",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00904598426",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 103.74,
      "maximum": 494.0,
      "gross_charge": 494.0,
      "discounted_cash": 271.7,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 205.998,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 153.14,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 103.74,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 345.8,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 494.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 103.74,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 181.0016,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 160.6488,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.9,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 306.774,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 296.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 469.3,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 469.3,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 494.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 491.53,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 494.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 296.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.7,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.7,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 197.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 193.154,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 162.032,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 199.576,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 165.984,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 481.8476,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 460.902,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 467.7192,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 447.5146,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 494.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 437.4864,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amnicore pro+, per sq cm",
  "code_information": [
    {
      "code": "Q4299",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 6379.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6379.875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amnicore pro, per sq cm",
  "code_information": [
    {
      "code": "Q4298",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 5812.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5812.775,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amnio bur dl mem per sq cm",
  "code_information": [
    {
      "code": "Q4365",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnio or derma tl, per sq cm",
  "code_information": [
    {
      "code": "Q4225",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 3956.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3956.325,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amnio quad-core, per sq cm",
  "code_information": [
    {
      "code": "Q4294",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 10102.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10102.194879,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6096.325,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amnio tri-core, per sq cm",
  "code_information": [
    {
      "code": "Q4295",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 9162.66,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9162.661214,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5529.225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amnio wound, per square cm",
  "code_information": [
    {
      "code": "Q4181",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnio-maxx or lite per sq cm",
  "code_information": [
    {
      "code": "Q4239",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 6379.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6379.875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amnioamp-mp per sq cm",
  "code_information": [
    {
      "code": "Q4250",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 5570.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5570.6875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amnioarmor 1 sq cm",
  "code_information": [
    {
      "code": "Q4188",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 1453.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1453.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amnioband, 1 mg",
  "code_information": [
    {
      "code": "Q4168",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 45.61,
      "maximum": 45.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.6087,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amnioband, guardian 1 sq cm",
  "code_information": [
    {
      "code": "Q4151",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 120.84,
      "maximum": 386.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 386.377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 120.84,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AMNIOCENTESIS DIAGNOSTIC",
  "code_information": [
    {
      "code": "59000",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1106.36,
      "maximum": 2655.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1106.3622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1106.3622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1687.21,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1497.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1496.383,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1106.3622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2655.26928,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1195.6346,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1184.6249,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1305.507396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1382.95275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1106.3622,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1184.6249,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1184.6249,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1106.3622,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMNIOCENTESIS THERAPEUTIC",
  "code_information": [
    {
      "code": "59001",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 386.5,
      "maximum": 927.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 589.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 523.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 522.7565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 927.60912,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.5759,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.9333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 483.12975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.074484,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.9333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.9333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniocore per sq cm",
  "code_information": [
    {
      "code": "Q4227",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 2778.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2778.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 290.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amniocore sl, per sq cm",
  "code_information": [
    {
      "code": "Q4367",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniodefend ft per sq cm",
  "code_information": [
    {
      "code": "Q4379",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnioexcel biodexcel 1sq cm",
  "code_information": [
    {
      "code": "Q4137",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 279.99,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 279.9922,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amniomatrixf3x per sq cm",
  "code_information": [
    {
      "code": "Q4409",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniomatrixf4x per sq cm",
  "code_information": [
    {
      "code": "Q4411",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnion bio or axobio sq cm",
  "code_information": [
    {
      "code": "Q4211",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnioplast 1, per sq cm",
  "code_information": [
    {
      "code": "Q4334",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnioplast 2, per sq cm",
  "code_information": [
    {
      "code": "Q4335",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnioplast 3 per sq cm",
  "code_information": [
    {
      "code": "Q4369",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amnioplast double per sq cm",
  "code_information": [
    {
      "code": "Q4391",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniorepair or altiply sq cm",
  "code_information": [
    {
      "code": "Q4235",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 150.55,
      "maximum": 401.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 401.1697,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 150.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amniotext patch, per sq cm",
  "code_information": [
    {
      "code": "Q4247",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 3242.37,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3242.3675,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 530.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AMNIOTIC FLUID SCAN",
  "code_information": [
    {
      "code": "82143",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.48,
      "maximum": 22.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.377376,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.4368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniotx, per sq cm",
  "code_information": [
    {
      "code": "Q4324",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amniowrap2 per sq cm",
  "code_information": [
    {
      "code": "Q4221",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 4962.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4962.125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amniply, per sq cm",
  "code_information": [
    {
      "code": "Q4249",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 1997.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1997.262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amobarbital 125 mg inj",
  "code_information": [
    {
      "code": "J0300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.88,
      "maximum": 500.04,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.877411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 186.932,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 186.932,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 500.0377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 187.72,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amox-Clav 875-125 MG Tablet",
  "drug_information": {
    "unit": 875.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00093227534",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.49,
      "maximum": 73.76,
      "gross_charge": 73.76,
      "discounted_cash": 40.57,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.75792,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.8656,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.4896,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 51.632,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.76,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.4896,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.025664,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.986752,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.80496,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 44.256,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.816,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 70.072,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 70.072,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 73.76,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 73.3912,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 73.76,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.256,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.568,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40.568,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.504,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.84016,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.19328,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.79904,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.78336,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 71.945504,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 68.81808,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 69.835968,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 66.819184,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 73.76,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 65.321856,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amoxicillin 125 MG/5 Ml Susp",
  "drug_information": {
    "unit": 125.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00143988801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.94,
      "maximum": 9.23,
      "gross_charge": 9.23,
      "discounted_cash": 5.08,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.84891,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.8613,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.9383,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.461,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.23,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.9383,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.381872,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.001596,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.73183,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 5.538,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.2305,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.7685,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.7685,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.23,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.18385,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.23,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.538,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.0765,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.0765,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.692,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.60893,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.02744,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.72892,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.10128,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.002942,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.61159,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.738964,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.361457,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.23,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.174088,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amoxicillin 250 MG Capsule",
  "drug_information": {
    "unit": 250.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00093310701",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.66,
      "maximum": 93.64,
      "gross_charge": 93.64,
      "discounted_cash": 51.5,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.04788,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.0284,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.6644,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.548,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 93.64,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.6644,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.309696,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.451728,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.774,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 58.15044,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 56.184,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.958,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.958,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.64,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.1718,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.64,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56.184,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.502,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.502,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.456,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.61324,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.71392,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.83056,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.46304,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.336456,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 87.36612,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 88.658352,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 84.828476,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 93.64,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 82.927584,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amoxicillin 250 MG/5 Ml Susp",
  "drug_information": {
    "unit": 250.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00093415579",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.23,
      "maximum": 15.37,
      "gross_charge": 15.37,
      "discounted_cash": 8.45,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.40929,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.7647,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.2277,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.759,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.37,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.2277,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.998324,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.631568,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.3795,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.54477,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 9.222,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.6015,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.6015,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.37,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.29315,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.37,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.222,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.4535,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.4535,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.148,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.00967,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.04136,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.20948,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.16432,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.991898,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.34021,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.552316,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.923683,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.37,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.611672,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Ampho b cholesteryl sulfate",
  "code_information": [
    {
      "code": "J0288",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.49,
      "maximum": 73.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.396309,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.45,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amphotericin b",
  "code_information": [
    {
      "code": "J0285",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 29.08,
      "maximum": 125.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.223603,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 125.4575,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.08,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Amphotericin B 50 MG Vial",
  "drug_information": {
    "unit": 50.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "39822105505",
      "type": "NDC"
    },
    {
      "code": "39822105505_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 965.0,
      "gross_charge": 965.0,
      "discounted_cash": 530.75,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 315.555,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 202.65,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 675.5,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 965.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 202.65,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 353.576,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 313.818,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.75,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 599.265,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 579.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 239.32,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 239.32,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 965.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 960.175,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 965.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 579.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 530.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 530.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 386.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 377.315,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 316.52,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 389.86,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 324.24,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 941.261,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 900.345,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 913.662,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 874.1935,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 965.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 854.604,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Amphotericin b lipid complex",
  "code_information": [
    {
      "code": "J0287",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.79,
      "maximum": 90.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 90.146504,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.785,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.71,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10.71,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.6492,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.9125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.1334,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.0872,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.13,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amphotericin b liposome inj",
  "code_information": [
    {
      "code": "J0289",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20.72,
      "maximum": 147.71,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 147.706265,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.1445,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.119,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.119,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.8602,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.5294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.1625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.6177,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ampicillin 1 Gm Vial",
  "drug_information": {
    "unit": 1.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "00781340495",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 467.0,
      "gross_charge": 467.0,
      "discounted_cash": 256.85,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 152.709,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 98.07,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 326.9,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 467.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 98.07,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 171.1088,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 151.8684,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 290.007,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 280.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.45,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 115.816,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 115.816,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 467.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 464.665,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 467.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 256.85,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 256.85,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 186.8,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 182.597,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 153.176,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 188.668,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 156.912,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 455.5118,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 435.711,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 442.1556,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 423.0553,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 467.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 413.5752,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Ampicillin 2 Gm Vial",
  "drug_information": {
    "unit": 2.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "00781340895",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 577.0,
      "gross_charge": 577.0,
      "discounted_cash": 317.35,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 188.679,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 121.17,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 403.9,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 577.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 121.17,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 187.6404,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 211.4128,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 358.317,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 346.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 201.95,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 143.096,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 143.096,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 577.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 574.115,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 577.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 346.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 317.35,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 317.35,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 230.8,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.256,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 225.607,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 193.872,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 233.108,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 562.8058,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 538.341,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 546.3036,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 522.7043,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 577.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 510.9912,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Ampicillin 250 MG Vial",
  "drug_information": {
    "unit": 30.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00781340295",
      "type": "NDC"
    },
    {
      "code": "00781340295_2",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 30.09,
      "gross_charge": 30.09,
      "discounted_cash": 16.55,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 9.83943,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.3189,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.445646,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.09,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.3189,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.785268,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.024976,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.68589,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.5075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.5075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.5315,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.46232,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.46232,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.09,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.93955,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.09,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.054,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.5495,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.5495,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.76519,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.86952,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.15636,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.11024,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 29.349786,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 28.07397,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 28.489212,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 27.258531,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.09,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.647704,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    },
    {
      "minimum": 0.47,
      "maximum": 36.72,
      "gross_charge": 36.72,
      "discounted_cash": 20.2,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 12.00744,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.7112,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.445646,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.7112,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 11.941344,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.454208,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.5075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.852,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.80312,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.5075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.10656,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.10656,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.5364,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.032,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.196,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.196,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.35752,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.04416,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.83488,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.33792,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 35.816688,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.25976,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.766496,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.264648,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.72,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 32.519232,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Ampicillin 500 MG Vial",
  "drug_information": {
    "unit": 250.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00781340795",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 43.25,
      "gross_charge": 43.25,
      "discounted_cash": 23.79,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 14.14275,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.0825,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.445646,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43.25,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.0825,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.8468,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 14.0649,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.1375,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.85825,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.5075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.5075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.726,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.726,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.25,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.03375,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.25,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.95,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.7875,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.7875,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.91075,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.186,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.473,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.532,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 42.18605,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 40.35225,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 40.9491,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 39.180175,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.25,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 38.3022,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Ampicillin sulbactam 1.5 gm",
  "code_information": [
    {
      "code": "J0295",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.28,
      "maximum": 31.98,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.977645,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.284,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.1895,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ampicillin-Sulbactam 3 Gm Vial",
  "drug_information": {
    "unit": 3.0,
    "type": "GR"
  },
  "code_information": [
    {
      "code": "00641611710",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 781.0,
      "gross_charge": 781.0,
      "discounted_cash": 429.55,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 255.387,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 164.01,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 546.7,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 781.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 164.01,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 286.1584,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 253.9812,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 485.001,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 468.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 273.35,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 193.688,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 193.688,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 781.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 777.095,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 781.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 468.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 429.55,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 429.55,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 312.4,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 305.371,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 256.168,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 315.524,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 262.416,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 761.7874,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 728.673,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 739.4508,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 707.5079,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 781.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 691.6536,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AMPUTATE HAND AT WRIST",
  "code_information": [
    {
      "code": "25922",
      "type": "HCPCS"
    },
    {
      "code": "25920",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2033.48,
      "maximum": 4880.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2753.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3101.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2750.326,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4880.35416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2087.3671,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2399.507462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2541.851125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATE LEG AT THIGH",
  "code_information": [
    {
      "code": "27590",
      "type": "HCPCS"
    },
    {
      "code": "27591",
      "type": "HCPCS"
    },
    {
      "code": "27592",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4208.34,
      "maximum": 4247.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATE LOWER LEG AT KNEE",
  "code_information": [
    {
      "code": "27598",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4208.34,
      "maximum": 4247.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATE METACARPAL BONE",
  "code_information": [
    {
      "code": "26910",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATE UPPER ARM & IMPLANT",
  "code_information": [
    {
      "code": "24931",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16512.69,
      "maximum": 16666.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION FOLLOW-UP SURGERY",
  "code_information": [
    {
      "code": "24925",
      "type": "HCPCS"
    },
    {
      "code": "25907",
      "type": "HCPCS"
    },
    {
      "code": "25909",
      "type": "HCPCS"
    },
    {
      "code": "25929",
      "type": "HCPCS"
    },
    {
      "code": "25931",
      "type": "HCPCS"
    },
    {
      "code": "27594",
      "type": "HCPCS"
    },
    {
      "code": "27884",
      "type": "HCPCS"
    },
    {
      "code": "24930",
      "type": "HCPCS"
    },
    {
      "code": "25924",
      "type": "HCPCS"
    },
    {
      "code": "27596",
      "type": "HCPCS"
    },
    {
      "code": "27886",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2324.22,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3544.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3146.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3143.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5578.12704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2678.3867,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.7234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2742.579128,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2905.2745,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.7234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.7234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC",
  "code_information": [
    {
      "code": "240",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27718.71,
      "maximum": 58899.88,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27718.71,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27718.71,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 58899.8815,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 52292.4225,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35501.7375,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27718.71,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47535.96418,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27718.71,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27718.71,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32964.1378,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34919.6375,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27935.71,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27718.71,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27935.71,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC",
  "code_information": [
    {
      "code": "239",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 47513.22,
      "maximum": 101697.09,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47513.22,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47513.22,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 90288.5865,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101697.0871,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 61403.307,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47513.22,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 82076.041012,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47513.22,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47513.22,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60056.925,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56693.7372,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48045.54,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47513.22,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48045.54,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "241",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13707.15,
      "maximum": 28605.86,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13707.15,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13707.15,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25396.818,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28605.8572,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18406.725,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13707.15,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23086.752784,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13707.15,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13707.15,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17302.6232,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18329.05,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14663.24,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13707.15,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14663.24,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC",
  "code_information": [
    {
      "code": "475",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 20790.74,
      "maximum": 47022.79,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22225.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22225.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41747.7165,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 47022.7891,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26298.983,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22225.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37950.392452,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22225.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22225.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25988.425,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24533.0732,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20790.74,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22225.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20790.74,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC",
  "code_information": [
    {
      "code": "474",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 41503.76,
      "maximum": 88704.19,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41503.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41503.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 78753.2505,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88704.1927,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 54671.607,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41503.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 71589.945844,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41503.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41503.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 53523.85,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50526.5144,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42819.08,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41503.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42819.08,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "476",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11380.85,
      "maximum": 24386.47,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11755.61,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11755.61,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21650.769,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24386.4726,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14178.997,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11755.61,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19681.440072,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11755.61,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11755.61,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14226.0625,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13429.403,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11380.85,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11755.61,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11380.85,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF FINGER/THUMB",
  "code_information": [
    {
      "code": "26951",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF FOOT AT ANKLE",
  "code_information": [
    {
      "code": "27888",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4208.34,
      "maximum": 4247.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF FOREARM",
  "code_information": [
    {
      "code": "25900",
      "type": "HCPCS"
    },
    {
      "code": "25905",
      "type": "HCPCS"
    },
    {
      "code": "25915",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9332.7,
      "maximum": 9419.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF HAND",
  "code_information": [
    {
      "code": "25927",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4208.34,
      "maximum": 4247.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF LEG AT HIP",
  "code_information": [
    {
      "code": "27290",
      "type": "HCPCS"
    },
    {
      "code": "27295",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF LOWER LEG",
  "code_information": [
    {
      "code": "27880",
      "type": "HCPCS"
    },
    {
      "code": "27881",
      "type": "HCPCS"
    },
    {
      "code": "27882",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4208.34,
      "maximum": 9419.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",
  "code_information": [
    {
      "code": "617",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 18350.91,
      "maximum": 38646.01,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18350.91,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18350.91,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38646.0089,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34310.6535,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23547.5455,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18350.91,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31189.796108,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18350.91,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18350.91,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22012.3572,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23318.175,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18654.54,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18350.91,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18654.54,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",
  "code_information": [
    {
      "code": "616",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 33805.58,
      "maximum": 72060.15,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33805.58,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33805.58,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63976.353,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72060.1462,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47117.036,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33805.58,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58157.137864,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33805.58,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33805.58,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46192.2,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 43605.4368,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36953.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 33805.58,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36953.76,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "618",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12156.96,
      "maximum": 29306.33,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14031.13,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14031.13,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26018.7135,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29306.3329,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15178.6345,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14031.13,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23652.081388,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14031.13,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14031.13,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14345.2128,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15196.2,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12156.96,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14031.13,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12156.96,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF MIDFOOT",
  "code_information": [
    {
      "code": "28800",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4208.34,
      "maximum": 4247.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF TOE",
  "code_information": [
    {
      "code": "28820",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION OF UPPER ARM",
  "code_information": [
    {
      "code": "24900",
      "type": "HCPCS"
    },
    {
      "code": "24920",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16512.69,
      "maximum": 16666.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION THRU METATARSAL",
  "code_information": [
    {
      "code": "28805",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AMPUTATION TOE & METATARSAL",
  "code_information": [
    {
      "code": "28810",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Amputee adapter",
  "code_information": [
    {
      "code": "E0959",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 44.21,
      "maximum": 44.21,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.21,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ana crown exp 1-3 per quad",
  "code_information": [
    {
      "code": "D4231",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1882.11,
      "maximum": 4517.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2548.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2870.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2545.601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4517.07456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2014.1424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2352.643,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2220.894992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ana crown exp 4 or> per quad",
  "code_information": [
    {
      "code": "D4230",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4120.64,
      "maximum": 9889.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5578.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6283.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5573.232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9889.54728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4303.8653,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4264.2342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4862.360746,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5150.805875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4264.2342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4264.2342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4120.6447,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Anacaulase-bcdb 8.8% gel 1 g",
  "code_information": [
    {
      "code": "J7353",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 55.39,
      "maximum": 269.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 269.221316,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 56.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 56.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.3945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.4205,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.4205,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.944,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 156.2735,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 72.925,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 68.8412,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.0887,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.34,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Anafranil 25 MG Capsule",
  "drug_information": {
    "unit": 25.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00406990603",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.2,
      "maximum": 120.0,
      "gross_charge": 120.0,
      "discounted_cash": 66.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.04,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.2,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.2,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 84.0,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 120.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.2,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.968,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 39.024,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.0,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 74.52,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 72.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 114.0,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 114.0,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 120.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 119.4,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 120.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 72.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.92,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.36,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.48,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.32,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 117.048,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 111.96,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 113.616,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 108.708,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 120.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 106.272,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANAL AND STOMAL PROCEDURES WITH CC",
  "code_information": [
    {
      "code": "348",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12287.58,
      "maximum": 27043.73,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12984.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12984.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27043.7344,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24009.936,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15346.87,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12984.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21826.019968,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12984.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12984.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15359.475,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14499.3444,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12287.58,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12984.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12287.58,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANAL AND STOMAL PROCEDURES WITH MCC",
  "code_information": [
    {
      "code": "347",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22415.51,
      "maximum": 47433.98,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22415.51,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22415.51,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42112.782,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 47433.9828,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28852.9345,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22415.51,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38282.252016,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22415.51,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22415.51,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28467.0125,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26872.8598,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22773.61,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22415.51,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22773.61,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "349",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8709.89,
      "maximum": 17989.21,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8796.75,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8796.75,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15971.157,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17989.2078,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10738.781,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8796.75,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14518.439016,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8796.75,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8796.75,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10277.6702,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10887.3625,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8709.89,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8796.75,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8709.89,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANAL SP INF PMP W/REPRG&FILL",
  "code_information": [
    {
      "code": "62369",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 381.07,
      "maximum": 914.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 581.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 515.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 515.4035,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 914.55744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.7016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 476.332,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.657408,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANAL/URINARY MUSCLE STUDY",
  "code_information": [
    {
      "code": "51784",
      "type": "HCPCS"
    },
    {
      "code": "51785",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 165.5,
      "maximum": 741.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 309.0226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 309.0226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 303.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 269.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 418.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 471.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 268.869,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 417.9525,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 309.0226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 477.11544,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 741.65424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 167.0331,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 324.3334,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 321.3468,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 248.497625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 234.581758,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 364.646668,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.27825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 309.0226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 321.3468,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 165.495,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 321.3468,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 198.7981,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 309.0226,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Analpram Hc 2.5%-1% Cream",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "54766079904",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 52.5,
      "maximum": 250.0,
      "gross_charge": 250.0,
      "discounted_cash": 137.5,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 104.25,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.5,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.5,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 175.0,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 250.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.5,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 81.3,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.6,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 87.5,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 155.25,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 150.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 237.5,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 237.5,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 250.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 248.75,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 250.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 150.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.5,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.5,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 100.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 97.75,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 82.0,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.0,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 84.0,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 243.85,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 233.25,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 236.7,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 226.475,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 250.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.4,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANALYSIS NERVE",
  "code_information": [
    {
      "code": "88356",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 67.02,
      "maximum": 180.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.8882,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.8882,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 103.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 91.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 91.8175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.8882,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 162.93168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 176.666737,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 165.1091,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.6467,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.0238,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 84.86025,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 80.108076,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 180.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.8882,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.0238,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.0238,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.8882,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANALYSIS TUMOR",
  "code_information": [
    {
      "code": "88358",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 66.78,
      "maximum": 522.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 217.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 217.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 332.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 294.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 294.4905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 217.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 522.552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 134.385901,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 125.5943,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.1606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 219.1241,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 272.1625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 256.9214,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66.78,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 217.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 219.1241,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 219.1241,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 217.73,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANALYZE SP INF PUMP W/REPROG",
  "code_information": [
    {
      "code": "62368",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 381.07,
      "maximum": 914.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 515.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 581.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 515.4035,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 914.55744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.7016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.657408,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 476.332,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANALYZE SPINE INFUS PUMP",
  "code_information": [
    {
      "code": "62367",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 381.07,
      "maximum": 914.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 515.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 581.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 515.4035,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 914.55744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.7016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 476.332,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.657408,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANAPLSMA PHGCYTOPHLM AMP PRB",
  "code_information": [
    {
      "code": "87468",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 35.09,
      "maximum": 84.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 84.216,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 53.938807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.4101,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.09,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Anastrozole 1 mg",
  "code_information": [
    {
      "code": "S0170",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.41,
      "maximum": 80.71,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 80.705485,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.408,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.408,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.3107,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Anastrozole 1 MG Tablet",
  "drug_information": {
    "unit": 1.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00093753656",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 34.65,
      "maximum": 165.0,
      "gross_charge": 165.0,
      "discounted_cash": 90.75,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 68.805,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 51.15,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.65,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 115.5,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 165.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34.65,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 60.456,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.658,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.75,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 102.465,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 156.75,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 156.75,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 165.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 164.175,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 165.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 99.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 64.515,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 54.12,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 66.66,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.44,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 160.941,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 153.945,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 156.222,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 149.4735,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 165.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 146.124,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Anavip Vial",
  "drug_information": {
    "unit": 120.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "66621079002",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 6660.0,
      "gross_charge": 6660.0,
      "discounted_cash": 3663.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2177.82,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1398.6,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4662.0,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6660.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1398.6,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2165.832,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2440.224,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4135.86,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 3996.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2331.0,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1651.68,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1651.68,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 6660.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6626.7,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6660.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3996.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3663.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3663.0,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2664.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2604.06,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2184.48,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2690.64,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2237.76,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 6496.164,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6213.78,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 6305.688,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6033.294,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6660.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5898.096,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANCA SCREEN EACH ANTIBODY",
  "code_information": [
    {
      "code": "86036",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.05,
      "maximum": 28.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.515601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.3043,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANCA TITER EACH ANTIBODY",
  "code_information": [
    {
      "code": "86037",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.05,
      "maximum": 28.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.515601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.3043,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ancobon 500 MG Capsule",
  "drug_information": {
    "unit": 500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00187355510",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 1132.0,
      "gross_charge": 1132.0,
      "discounted_cash": 622.6,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 370.164,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 237.72,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 792.4,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1132.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 237.72,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 414.7648,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 368.1264,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 702.972,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 679.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 396.2,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 280.736,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 280.736,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1132.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1126.34,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1132.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 679.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 622.6,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 622.6,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 452.8,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 442.612,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 371.296,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 457.328,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 380.352,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1104.1528,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1056.156,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1071.7776,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1025.4788,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1132.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1002.4992,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANDROLOGY INFERTILITY ASSMT",
  "code_information": [
    {
      "code": "0255U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 31.6,
      "maximum": 75.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.84,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.570938,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 45.3934,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.6,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANDROSTANEDIOL GLUCURONIDE",
  "code_information": [
    {
      "code": "82154",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.63,
      "maximum": 69.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.192,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.314478,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.4154,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.63,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANES 2&3 BURN 4-9% TBSA",
  "code_information": [
    {
      "code": "01952",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES 2&3 BURN EA ADD 9% TBSA",
  "code_information": [
    {
      "code": "01953",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.61,
      "maximum": 12.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.61,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES 2&3 BURN LESS 4 % TBSA",
  "code_information": [
    {
      "code": "01951",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ACCESS CTR VENOUS CRCJ",
  "code_information": [
    {
      "code": "00532",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL CLOSED PX HIP JOINT",
  "code_information": [
    {
      "code": "01200",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL CLSD PX KNEE JOINT",
  "code_information": [
    {
      "code": "01380",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX INTEG H/N/PTRUNK",
  "code_information": [
    {
      "code": "00300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX LARYNX&TRACH<1YR",
  "code_information": [
    {
      "code": "00326",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX NCK NDL BX THYR",
  "code_information": [
    {
      "code": "00322",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX NECK NOS 1YR/>",
  "code_information": [
    {
      "code": "00320",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX NRV MSC KNE&/POP",
  "code_information": [
    {
      "code": "01320",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX NRV MUSC SHO&AX",
  "code_information": [
    {
      "code": "01610",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX NRV MUSC UPR LEG",
  "code_information": [
    {
      "code": "01250",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX ON ESOPHAGUS",
  "code_information": [
    {
      "code": "00500",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX VEINS UPPER LEG",
  "code_information": [
    {
      "code": "01260",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ALL PX VN SHOULDER&AX",
  "code_information": [
    {
      "code": "01670",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ANORECTAL PX",
  "code_information": [
    {
      "code": "00902",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ART F/ARM WRST&HND NOS",
  "code_information": [
    {
      "code": "01840",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ART FARM WRST&HND EMBLC",
  "code_information": [
    {
      "code": "01842",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ART SHO&AX AX-BRCH ARSM",
  "code_information": [
    {
      "code": "01652",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ART SHO&AX AX-FEM BPG",
  "code_information": [
    {
      "code": "01656",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ART SHO&AX BYPASS GRF",
  "code_information": [
    {
      "code": "01654",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ART SHO&AX NOS",
  "code_information": [
    {
      "code": "01650",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ART UPR ARM&ELBW EMBLC",
  "code_information": [
    {
      "code": "01772",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ARTHR/NDSC TOT WRST RPL",
  "code_information": [
    {
      "code": "01832",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ARTHR/NDSC WRST/HND NOS",
  "code_information": [
    {
      "code": "01830",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ARTHROSCOPIC PX HIP JT",
  "code_information": [
    {
      "code": "01202",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ARTHRS PX ANKLE&/FOOT",
  "code_information": [
    {
      "code": "01464",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES BODY CAST APPL/REVJ",
  "code_information": [
    {
      "code": "01130",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES BONE MARROW ASPIR&/BX",
  "code_information": [
    {
      "code": "01112",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES C HYST FLWG NEURAXIAL",
  "code_information": [
    {
      "code": "01969",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 77.11,
      "maximum": 77.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CARDIAC CATHETERIZATION",
  "code_information": [
    {
      "code": "01920",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CARDIAC EP PROCEDURES",
  "code_information": [
    {
      "code": "00537",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CESAREAN DELIVERY ONLY",
  "code_information": [
    {
      "code": "01961",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 107.82,
      "maximum": 107.82,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 107.82,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CESAREAN HYSTERECTOMY",
  "code_information": [
    {
      "code": "01963",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.17,
      "maximum": 101.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.17,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLOSED CHEST PX NOS",
  "code_information": [
    {
      "code": "00520",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLS PX UPR TIB FIB&/PAT",
  "code_information": [
    {
      "code": "01390",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD CH MEDIAST&THRC W/",
  "code_information": [
    {
      "code": "00529",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 139.12,
      "maximum": 139.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 139.12,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD CH MEDIAST&THRC WO",
  "code_information": [
    {
      "code": "00528",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD CH PX NDL BX PLEUR",
  "code_information": [
    {
      "code": "00522",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD CH PX PNEUMOCENTS",
  "code_information": [
    {
      "code": "00524",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD PX HUMERUS&ELBOW",
  "code_information": [
    {
      "code": "01730",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD PX LOWER 1/3 FEMUR",
  "code_information": [
    {
      "code": "01340",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD PX LOWER L/A/F",
  "code_information": [
    {
      "code": "01462",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD PX RDS U/W/H BONES",
  "code_information": [
    {
      "code": "01820",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD PX SHOULDER JOINT",
  "code_information": [
    {
      "code": "01620",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD PX SYMPH PUB/SI JT",
  "code_information": [
    {
      "code": "01160",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CLSD PX UPPER 2/3 FEMUR",
  "code_information": [
    {
      "code": "01220",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES CST APPL RMV/RPR KNE JT",
  "code_information": [
    {
      "code": "01420",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES DIRECT CABG W/O PUMP",
  "code_information": [
    {
      "code": "00566",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 316.35,
      "maximum": 316.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 316.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES DX ARTERIOGRAPHY/VNGRPH",
  "code_information": [
    {
      "code": "01916",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES DX ARTHR PX SHOULDER JT",
  "code_information": [
    {
      "code": "01622",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES DX ARTHROSCOPIC PX WRST",
  "code_information": [
    {
      "code": "01829",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES DX ARTHRS PX ELBOW JT",
  "code_information": [
    {
      "code": "01732",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES DX ARTHRS PX KNEE JT",
  "code_information": [
    {
      "code": "01382",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES DX/THER LUMBAR PNXR",
  "code_information": [
    {
      "code": "00635",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES DX/THER NRV BLK&INJ OTH",
  "code_information": [
    {
      "code": "01991",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES DX/THER NRV BLK&INJ PRN",
  "code_information": [
    {
      "code": "01992",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ELECTROCONVULSIVE THER",
  "code_information": [
    {
      "code": "00104",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES FOR STERNAL DEBRIDEMENT",
  "code_information": [
    {
      "code": "00550",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES FOREARM WRIST/HAND CAST",
  "code_information": [
    {
      "code": "01860",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES GASTROCNEMIUS RECESSION",
  "code_information": [
    {
      "code": "01474",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES HEART/LUNG TRANSPLANT",
  "code_information": [
    {
      "code": "00580",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 253.02,
      "maximum": 253.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 253.02,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES HERNIA REPAIR VNT&INCAL",
  "code_information": [
    {
      "code": "00832",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES HERNIA REPAIR<1 YR AGE",
  "code_information": [
    {
      "code": "00834",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES HERNIA RPR LWR ABD NOS",
  "code_information": [
    {
      "code": "00830",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES HRNA RPR DIPHRG HRNA",
  "code_information": [
    {
      "code": "00756",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES HRNA RPR LMBR&VNT&/DEHS",
  "code_information": [
    {
      "code": "00752",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES HRNA RPR OMPHALOCELE",
  "code_information": [
    {
      "code": "00754",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES HRNA RPR UPR ABD NOS",
  "code_information": [
    {
      "code": "00750",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES HRNA RPR<37WK BRTH<50",
  "code_information": [
    {
      "code": "00836",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ICR PX BURR HOLES",
  "code_information": [
    {
      "code": "00214",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 113.9,
      "maximum": 113.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 113.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ICR PX CRNOP/ELVTN FX",
  "code_information": [
    {
      "code": "00215",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 113.9,
      "maximum": 113.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 113.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ICR PX CSF SHUNTING PX",
  "code_information": [
    {
      "code": "00220",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ICR PX ECOAG ICR NRV",
  "code_information": [
    {
      "code": "00222",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ICR PX IN SITTING POS",
  "code_information": [
    {
      "code": "00218",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 164.48,
      "maximum": 164.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ICR PX SUBDURAL TAPS",
  "code_information": [
    {
      "code": "00212",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES ICR PX VASCULAR PX",
  "code_information": [
    {
      "code": "00216",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INCOMPL/MISSED AB PX",
  "code_information": [
    {
      "code": "01965",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 61.59,
      "maximum": 61.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 61.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INDUCED ABORTION PX",
  "code_information": [
    {
      "code": "01966",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 61.59,
      "maximum": 61.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 61.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INSERTION/RPLCMT CVDFB",
  "code_information": [
    {
      "code": "00534",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INSJ PENILE PROSTHESIS",
  "code_information": [
    {
      "code": "00938",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INTEG SYS CONV ARRHYT",
  "code_information": [
    {
      "code": "00410",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INTEG SYS RAD BRST DSJ",
  "code_information": [
    {
      "code": "00406",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 164.48,
      "maximum": 164.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INTEG SYS RAD/MODF BRST",
  "code_information": [
    {
      "code": "00404",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INTEG SYS RCNSTV BREAST",
  "code_information": [
    {
      "code": "00402",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INTEGUMENTARY SYS NOS",
  "code_information": [
    {
      "code": "00400",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INTRACRANIAL PX NOS",
  "code_information": [
    {
      "code": "00210",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 139.12,
      "maximum": 139.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 139.12,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INTRAORAL PX NOS",
  "code_information": [
    {
      "code": "00170",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES INTRAORAL PX RAD SURG",
  "code_information": [
    {
      "code": "00176",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER PX ABDMNPRNL RESCJ",
  "code_information": [
    {
      "code": "00844",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER PX AMNIOCENTESIS",
  "code_information": [
    {
      "code": "00842",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 61.59,
      "maximum": 61.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 61.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER PX LOWER ABD NOS",
  "code_information": [
    {
      "code": "00840",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER PX PEL EXENTRATION",
  "code_information": [
    {
      "code": "00848",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER PX RAD HYSTRECTOMY",
  "code_information": [
    {
      "code": "00846",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER PX TUBAL LIGATION",
  "code_information": [
    {
      "code": "00851",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER UPR ABD GSTR PX MO",
  "code_information": [
    {
      "code": "00797",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER UPR ABD LVR TRNSPL",
  "code_information": [
    {
      "code": "00796",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 379.53,
      "maximum": 379.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 379.53,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER UPR ABD NOS",
  "code_information": [
    {
      "code": "00790",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER UPR ABD PNCRTECT",
  "code_information": [
    {
      "code": "00794",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IPER UPR ABD PRTL HPTC",
  "code_information": [
    {
      "code": "00792",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 164.48,
      "maximum": 164.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IVNT RAD NTRHPT/PRT CRC",
  "code_information": [
    {
      "code": "01931",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IVNTL RAD ARTL CRTD/C",
  "code_information": [
    {
      "code": "01925",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES IVNTL RAD ICR ICAR/AORT",
  "code_information": [
    {
      "code": "01926",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES LITHOTRP ESW WATER BATH",
  "code_information": [
    {
      "code": "00872",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES LITHOTRP ESW WO WTR BTH",
  "code_information": [
    {
      "code": "00873",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES LWR INTST NDSC NOS",
  "code_information": [
    {
      "code": "00811",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 56.04,
      "maximum": 56.04,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 56.04,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES LWR INTST SCR COLSC",
  "code_information": [
    {
      "code": "00812",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 42.03,
      "maximum": 42.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.03,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES LWR LEG CST APP RMV/RPR",
  "code_information": [
    {
      "code": "01490",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES MAJ LWR ABD VESSEL NOS",
  "code_information": [
    {
      "code": "00880",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES MAJ LWR ADB VSL IVC LIG",
  "code_information": [
    {
      "code": "00882",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES MALE GENT COMPL AMP PNS",
  "code_information": [
    {
      "code": "00932",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES MALE GENT RAD ORCH ABD",
  "code_information": [
    {
      "code": "00928",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES MALE GENT RAD ORCH ING",
  "code_information": [
    {
      "code": "00926",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES MALE GENT UNDSCND TSTIS",
  "code_information": [
    {
      "code": "00924",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES N-INVAS IMG/RADJ THER",
  "code_information": [
    {
      "code": "01922",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES NRV MSC UPR A&E TNDSIS",
  "code_information": [
    {
      "code": "01716",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES NRV MSC UPR A&E TNPLSTY",
  "code_information": [
    {
      "code": "01714",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES NTRORAL PX RPR CLFT PAL",
  "code_information": [
    {
      "code": "00172",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES NTRORL EXC RTRPHRNG TUM",
  "code_information": [
    {
      "code": "00174",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES NTRPLVABDMNL AMPUTATION",
  "code_information": [
    {
      "code": "01140",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPEN PX HIP JOINT NOS",
  "code_information": [
    {
      "code": "01210",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPEN PX HIP JT DISRTCJ",
  "code_information": [
    {
      "code": "01212",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPEN PX LOWER 1/3 FEMUR",
  "code_information": [
    {
      "code": "01360",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPEN PX LOWER L/A/F NOS",
  "code_information": [
    {
      "code": "01480",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPEN PX TOT HIP ARTHRP",
  "code_information": [
    {
      "code": "01214",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPEN TOTAL ANKLE RPLCMT",
  "code_information": [
    {
      "code": "01486",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPEN/ARTHR NTRTHRC AMP",
  "code_information": [
    {
      "code": "01636",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPEN/ARTHRS SHO DISRTCJ",
  "code_information": [
    {
      "code": "01634",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 113.9,
      "maximum": 113.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 113.9,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN LW L/A/F OSTE/OSTPL",
  "code_information": [
    {
      "code": "01484",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN LWR L/A/F RAD RESCJ",
  "code_information": [
    {
      "code": "01482",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN PX SYMPH PUB/SI JT",
  "code_information": [
    {
      "code": "01170",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN PX UPR 2/3 FEM AMP",
  "code_information": [
    {
      "code": "01232",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN PX UPR TIB FIB&/PAT",
  "code_information": [
    {
      "code": "01392",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN REVJ TOT HIP ARTHRP",
  "code_information": [
    {
      "code": "01215",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN RPR FX DISRPJ PLVS",
  "code_information": [
    {
      "code": "01173",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 151.87,
      "maximum": 151.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 151.87,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN UPPER 2/3 FEMUR NOS",
  "code_information": [
    {
      "code": "01230",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN UPR 2/3 FEM RAD RES",
  "code_information": [
    {
      "code": "01234",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTH TOT KNE ARTHRP",
  "code_information": [
    {
      "code": "01402",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHR ELB TOT RPLCT",
  "code_information": [
    {
      "code": "01760",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHR PX SHO JT NOS",
  "code_information": [
    {
      "code": "01630",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHR TOT SHO RPLCM",
  "code_information": [
    {
      "code": "01638",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHRS DISRTCJ KNEE",
  "code_information": [
    {
      "code": "01404",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHRS ELBW EXC CST",
  "code_information": [
    {
      "code": "01758",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHRS ELBW OSTEOT",
  "code_information": [
    {
      "code": "01742",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHRS ELBW RAD PX",
  "code_information": [
    {
      "code": "01756",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHRS ELBW RPR HUM",
  "code_information": [
    {
      "code": "01744",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHRS KNEE JT NOS",
  "code_information": [
    {
      "code": "01400",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES OPN/ARTHRS PX ELBW NOS",
  "code_information": [
    {
      "code": "01740",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PARTIAL RIB RESCJ NOS",
  "code_information": [
    {
      "code": "00470",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PERINEAL PROSTATECTOMY",
  "code_information": [
    {
      "code": "00908",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PERM TRANSVNS PM INSJ",
  "code_information": [
    {
      "code": "00530",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PROCEDURES ON EYE NOS",
  "code_information": [
    {
      "code": "00140",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PRTL RIB RESCJ RAD PX",
  "code_information": [
    {
      "code": "00474",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 164.48,
      "maximum": 164.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PRTL RIB RESCJ THORACOP",
  "code_information": [
    {
      "code": "00472",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ART FEM ART EMBLC",
  "code_information": [
    {
      "code": "01274",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ART FEMORAL ART LIG",
  "code_information": [
    {
      "code": "01272",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ART KNEE&POP EXC&GRF",
  "code_information": [
    {
      "code": "01444",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ART KNEE&POP NOS",
  "code_information": [
    {
      "code": "01440",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ART KNEE&POP TEAEC",
  "code_information": [
    {
      "code": "01442",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ART LOWER LEG EMBLC",
  "code_information": [
    {
      "code": "01502",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ART LOWER LEG NOS",
  "code_information": [
    {
      "code": "01500",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ART UPR ARM&ELBW NOS",
  "code_information": [
    {
      "code": "01770",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ARTERIES UPR LEG NOS",
  "code_information": [
    {
      "code": "01270",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX CLAV&SCAPULA BX CLAV",
  "code_information": [
    {
      "code": "00454",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX CLAV&SCAPULA NOS",
  "code_information": [
    {
      "code": "00450",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX CRV SPINE&CORD NOS",
  "code_information": [
    {
      "code": "00600",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX CRV SPN&CORD SITTING",
  "code_information": [
    {
      "code": "00604",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 164.48,
      "maximum": 164.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX EAR OTOSCOPY",
  "code_information": [
    {
      "code": "00124",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX EAR TYMPANOTOMY",
  "code_information": [
    {
      "code": "00126",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX EAR W/BX NOS",
  "code_information": [
    {
      "code": "00120",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX EYE CORNEAL TRNSPL",
  "code_information": [
    {
      "code": "00144",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX EYE OPHTHALMOSCOPY",
  "code_information": [
    {
      "code": "00148",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX EYE VITREORTNL SURG",
  "code_information": [
    {
      "code": "00145",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX FACIAL B1/SKULL NOS",
  "code_information": [
    {
      "code": "00190",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX FCL B1/SKL RAD SURG",
  "code_information": [
    {
      "code": "00192",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX HEART W/O PUMP OXTJ",
  "code_information": [
    {
      "code": "00560",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX HEART W/PMP CRC ARST",
  "code_information": [
    {
      "code": "00563",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 316.35,
      "maximum": 316.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 316.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX HEART W/PUMP<1 YR",
  "code_information": [
    {
      "code": "00561",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 316.35,
      "maximum": 316.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 316.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX HRT W/PUMP AGE 1YR+",
  "code_information": [
    {
      "code": "00562",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 253.02,
      "maximum": 253.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 253.02,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX LUMBAR REGION NOS",
  "code_information": [
    {
      "code": "00630",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX LUMBAR SYMPATHECTOMY",
  "code_information": [
    {
      "code": "00632",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX LWR ABDL WAL PANNIC",
  "code_information": [
    {
      "code": "00802",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX LWR ANT ABDL WAL NOS",
  "code_information": [
    {
      "code": "00800",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX LWR POST ABDL WALL",
  "code_information": [
    {
      "code": "00820",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX MAJ ABD BLOOD VESSEL",
  "code_information": [
    {
      "code": "00770",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX MAJ VSL NCK SMPL LIG",
  "code_information": [
    {
      "code": "00352",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX MAJOR VSL NECK NOS",
  "code_information": [
    {
      "code": "00350",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX MALE GENITALIA NOS",
  "code_information": [
    {
      "code": "00920",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX MALE GENITALIA VASEC",
  "code_information": [
    {
      "code": "00921",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX MALE GENT ORCHIOPEXY",
  "code_information": [
    {
      "code": "00930",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX MALE GENT SEM VES",
  "code_information": [
    {
      "code": "00922",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX NOSE&SINS BX SFT TIS",
  "code_information": [
    {
      "code": "00164",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX NOSE&SINUS NOS",
  "code_information": [
    {
      "code": "00160",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX NOSE&SINUS RAD SURG",
  "code_information": [
    {
      "code": "00162",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX NRV MSC LW L/A/F NOS",
  "code_information": [
    {
      "code": "01470",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX NRV MSC UPR A&E TNOT",
  "code_information": [
    {
      "code": "01712",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX NRV MUSC F/ARM WRST",
  "code_information": [
    {
      "code": "01810",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX NRV MUSC UPR A&E NOS",
  "code_information": [
    {
      "code": "01710",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ON BONY PELVIS",
  "code_information": [
    {
      "code": "01120",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ON EYE IRIDECTOMY",
  "code_information": [
    {
      "code": "00147",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX ON EYE LENS SURGERY",
  "code_information": [
    {
      "code": "00142",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX PLSTC RPR CLEFT LIP",
  "code_information": [
    {
      "code": "00102",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX SALIVARY GLAND W/BX",
  "code_information": [
    {
      "code": "00100",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX THRC SPINE&CORD NOS",
  "code_information": [
    {
      "code": "00620",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX UPPER PST ABDL WALL",
  "code_information": [
    {
      "code": "00730",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX UPR ANT ABD WALL NOS",
  "code_information": [
    {
      "code": "00700",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX VEINS KNEE&POP NOS",
  "code_information": [
    {
      "code": "01430",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX VEINS LOWER LEG NOS",
  "code_information": [
    {
      "code": "01520",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX VN F/ARM PHLBRRHAPHY",
  "code_information": [
    {
      "code": "01852",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX VN KNEE&POP AV FSTL",
  "code_information": [
    {
      "code": "01432",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX VN LWR LEG VEN THRMB",
  "code_information": [
    {
      "code": "01522",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES PX VN UPR ARM&ELBW NOS",
  "code_information": [
    {
      "code": "01780",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES RAD AMP PENIS INGUN LYM",
  "code_information": [
    {
      "code": "00934",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES RAD AMP PNS INGUN&ILAC",
  "code_information": [
    {
      "code": "00936",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES RAD PX TUMOR OF PELVIS",
  "code_information": [
    {
      "code": "01150",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES RADICAL PERINEAL PX",
  "code_information": [
    {
      "code": "00904",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES RCNSTV PX EYELID",
  "code_information": [
    {
      "code": "00103",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES RPR RPT ACHILLES TENDON",
  "code_information": [
    {
      "code": "01472",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES SHO CAST APPL RMVL/RPR",
  "code_information": [
    {
      "code": "01680",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES SPINE MANIPULATION",
  "code_information": [
    {
      "code": "00640",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES TH IVNT RAD NTRTHRC/JUG",
  "code_information": [
    {
      "code": "01932",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THER IVNTL RAD ARTL NOS",
  "code_information": [
    {
      "code": "01924",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THER IVNTL RAD PX ICR",
  "code_information": [
    {
      "code": "01933",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THER IVNTL RAD VEN NOS",
  "code_information": [
    {
      "code": "01930",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THORACOTOMY PX NOS",
  "code_information": [
    {
      "code": "00540",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 164.48,
      "maximum": 164.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THRC SPINE W/1 LNG VENT",
  "code_information": [
    {
      "code": "00626",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THRC SPINE WO 1LNG VENT",
  "code_information": [
    {
      "code": "00625",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 164.48,
      "maximum": 164.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THRCM PX 1 LUNG VNTJ",
  "code_information": [
    {
      "code": "00541",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THRCM PX DECORTICATION",
  "code_information": [
    {
      "code": "00542",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THRCM PX PULM RESCJ",
  "code_information": [
    {
      "code": "00546",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES THRCM PX TRACH&BRONCHI",
  "code_information": [
    {
      "code": "00548",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 189.84,
      "maximum": 189.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 189.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES TRACHEOBRONCHIAL RCNSTJ",
  "code_information": [
    {
      "code": "00539",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 227.66,
      "maximum": 227.66,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 227.66,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES TRANSURETHRAL PX NOS",
  "code_information": [
    {
      "code": "00910",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES TRURL PX RESCJ BLDR TUM",
  "code_information": [
    {
      "code": "00912",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES TRURL PX RESCJ BLEEDING",
  "code_information": [
    {
      "code": "00916",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES TRURL PX RESCJ PRST8",
  "code_information": [
    {
      "code": "00914",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES TRURL PX URTRL CAL RMVL",
  "code_information": [
    {
      "code": "00918",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES UPR ANT ABD WALL LVR BX",
  "code_information": [
    {
      "code": "00702",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES UPR GI NDSC PX ERCP",
  "code_information": [
    {
      "code": "00732",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 84.06,
      "maximum": 84.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 84.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES UPR GI NDSC PX NOS",
  "code_information": [
    {
      "code": "00731",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 70.05,
      "maximum": 70.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 70.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES UPR LWR GI NDSC PX",
  "code_information": [
    {
      "code": "00813",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 70.05,
      "maximum": 70.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 70.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES URGENT HYSTERECTOMY",
  "code_information": [
    {
      "code": "01962",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.17,
      "maximum": 101.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.17,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VAG PX CLPTMY VGNC CLPR",
  "code_information": [
    {
      "code": "00942",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VAG PX CRV CERCLAGE",
  "code_information": [
    {
      "code": "00948",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 61.59,
      "maximum": 61.59,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 61.59,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VAG PX CULDOSCOPY",
  "code_information": [
    {
      "code": "00950",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VAG PX HYSTSC&/HSG",
  "code_information": [
    {
      "code": "00952",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VAG PX VAG HYSTERECTOMY",
  "code_information": [
    {
      "code": "00944",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VAGINAL DELIVERY ONLY",
  "code_information": [
    {
      "code": "01960",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 77.11,
      "maximum": 77.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VAGINAL PX NOS",
  "code_information": [
    {
      "code": "00940",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VASC SHUNT/SHUNT REVJ",
  "code_information": [
    {
      "code": "01844",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VEIN F/ARM WRST&HND NOS",
  "code_information": [
    {
      "code": "01850",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 37.97,
      "maximum": 37.97,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.97,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VN UPR ARM&ELBW PHLBRPY",
  "code_information": [
    {
      "code": "01782",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES VULVECTOMY",
  "code_information": [
    {
      "code": "00906",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 50.58,
      "maximum": 50.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 50.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES XTNSV SP&SPI CORD PX",
  "code_information": [
    {
      "code": "00670",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 164.48,
      "maximum": 164.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 164.48,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES XTRNL CEPHALIC VERSION",
  "code_information": [
    {
      "code": "01958",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 77.11,
      "maximum": 77.11,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES XTRPRT LW ABD ADRNLCTMY",
  "code_information": [
    {
      "code": "00866",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES XTRPRT LWR ABD PRST8ECT",
  "code_information": [
    {
      "code": "00865",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES XTRPRT LWR ABD TOT CSTC",
  "code_information": [
    {
      "code": "00864",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 101.15,
      "maximum": 101.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 101.15,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES XTRPRTL CYSTOLITHOTOMY",
  "code_information": [
    {
      "code": "00870",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 63.33,
      "maximum": 63.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 63.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES XTRPRTL LWR ABD RNL PX",
  "code_information": [
    {
      "code": "00862",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 88.54,
      "maximum": 88.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.54,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES XTRPRTL PX LWR ABD NOS",
  "code_information": [
    {
      "code": "00860",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.93,
      "maximum": 75.93,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.93,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES XTRPRTL PX RNL TRANSPL",
  "code_information": [
    {
      "code": "00868",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.51,
      "maximum": 126.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANES/ANALG CS DLVR NEURAXIAL",
  "code_information": [
    {
      "code": "01968",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 30.88,
      "maximum": 30.88,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Angina pectoris",
  "code_information": [
    {
      "code": "311",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6981.62,
      "maximum": 14503.36,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7184.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7184.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14503.3597,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12876.3555,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8512.76,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7184.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11705.137084,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7184.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7184.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8238.3116,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8727.025,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6981.62,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7184.48,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6981.62,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANGIOTENSIN I ENZYME TEST",
  "code_information": [
    {
      "code": "82164",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.98,
      "maximum": 35.04,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.04,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.441003,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20.9729,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.6,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Anidulafungin injection",
  "code_information": [
    {
      "code": "J0348",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.42,
      "maximum": 8.83,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.831921,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.4195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.4177,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.01,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ank symes mold sckt sach ft",
  "code_information": [
    {
      "code": "L5050",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 955.8,
      "maximum": 955.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 955.8,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ank-foot sys dors-plant flex",
  "code_information": [
    {
      "code": "L5973",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12453.0,
      "maximum": 12453.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12453.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANKLE ARTHROSCOPY/SURGERY",
  "code_information": [
    {
      "code": "29894",
      "type": "HCPCS"
    },
    {
      "code": "29895",
      "type": "HCPCS"
    },
    {
      "code": "29897",
      "type": "HCPCS"
    },
    {
      "code": "29898",
      "type": "HCPCS"
    },
    {
      "code": "29899",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ankle control ortho pre ots",
  "code_information": [
    {
      "code": "L4350",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 71.78,
      "maximum": 71.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 71.78,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANKLE DISARTICULATION",
  "code_information": [
    {
      "code": "27889",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANL SP INF PMP W/MDREPRG&FIL",
  "code_information": [
    {
      "code": "62370",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 381.07,
      "maximum": 914.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 515.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 581.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 515.4035,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 914.55744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.7016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 476.332,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 449.657408,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.0302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 381.0656,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Annual alcohol screen 15 min",
  "code_information": [
    {
      "code": "G0442",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16.5,
      "maximum": 90.84,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.1955,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.84288,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.6386,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.314,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.664416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.1907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.8512,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANOGENITAL EXAM CHILD W IMAG",
  "code_information": [
    {
      "code": "99170",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 108.8,
      "maximum": 613.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 389.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 346.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 345.7145,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 613.45584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 262.4424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.0258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.615788,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 319.50825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 108.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.0258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.0258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANORECTAL MANOMETRY",
  "code_information": [
    {
      "code": "91122",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 60.37,
      "maximum": 949.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 603.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 535.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 535.135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 949.59552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 494.581,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 466.884464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 60.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANORECTAL MYOMECTOMY",
  "code_information": [
    {
      "code": "45108",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3484.48,
      "maximum": 8362.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5313.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4717.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4712.817,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8362.75368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3603.1421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4111.687226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4355.600875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANOSC SBMCSL NJX BULKING AGT",
  "code_information": [
    {
      "code": "0963T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1498.14,
      "maximum": 3595.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3595.5336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1553.3847,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANOSCOPY",
  "code_information": [
    {
      "code": "46611",
      "type": "HCPCS"
    },
    {
      "code": "46615",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1158.42,
      "maximum": 8362.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1766.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1568.34,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4717.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5313.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1566.778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4712.817,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2780.20488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8362.75368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1207.1971,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3603.1421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1196.0809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1448.023375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1366.934066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4111.687226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4355.600875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1196.0809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1196.0809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANOSCOPY AND BIOPSY",
  "code_information": [
    {
      "code": "46606",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1498.14,
      "maximum": 3595.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2028.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2284.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2026.2645,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3595.5336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1553.3847,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1872.67375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1767.80402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANOSCOPY AND DILATION",
  "code_information": [
    {
      "code": "46604",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1498.14,
      "maximum": 3595.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2284.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2028.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2026.2645,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3595.5336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1553.3847,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1872.67375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1767.80402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANOSCOPY CONTROL BLEEDING",
  "code_information": [
    {
      "code": "46614",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1498.14,
      "maximum": 3595.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2028.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2284.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2026.2645,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3595.5336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1553.3847,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1767.80402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1872.67375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1539.0808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1498.139,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANOSCOPY REMOVE FOR BODY",
  "code_information": [
    {
      "code": "46608",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1158.42,
      "maximum": 2780.2,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1766.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1568.34,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1566.778,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2780.20488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1207.1971,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1196.0809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1448.023375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1366.934066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1196.0809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1196.0809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1158.4187,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANOSCOPY REMOVE LESION",
  "code_information": [
    {
      "code": "46610",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3484.48,
      "maximum": 8362.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4717.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5313.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4712.817,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8362.75368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3603.1421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4111.687226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4355.600875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANOSCOPY REMOVE LESIONS",
  "code_information": [
    {
      "code": "46612",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3484.48,
      "maximum": 8362.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5313.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4717.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4712.817,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8362.75368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3603.1421,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4111.687226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4355.600875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3569.9634,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3484.4807,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANRCT MANO RCT SNSATN&BALO",
  "code_information": [
    {
      "code": "91125",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 479.94,
      "maximum": 484.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 484.4035,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 479.943,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 479.943,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 479.943,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANS PARASYMP & SYMP W/TILT",
  "code_information": [
    {
      "code": "95924",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 128.82,
      "maximum": 949.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 603.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 535.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 535.135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 949.59552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.2944,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 494.581,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 466.884464,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 128.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 277.7133,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.6648,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANT LMBR VRT BDY TETH <7 SEG",
  "code_information": [
    {
      "code": "0656T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANT LMBR VRT BDY TETH 8+ SEG",
  "code_information": [
    {
      "code": "0657T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ant resin-based cmpst crown",
  "code_information": [
    {
      "code": "D2390",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANT SGM IMG I&R SPECLR MIC",
  "code_information": [
    {
      "code": "92286",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 163.78,
      "maximum": 393.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 249.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.521,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 393.07272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 193.260754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.725375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANT SGM IMG IR FLRSCN ANGRPH",
  "code_information": [
    {
      "code": "92287",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 163.78,
      "maximum": 393.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 249.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.521,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 393.07272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 193.260754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.725375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANT THRC VRT BODY TETHRG <7",
  "code_information": [
    {
      "code": "22836",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANT THRC VRT BODY TETHRG 8+",
  "code_information": [
    {
      "code": "22837",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTB TP TOTAL&RPR IA QUAL",
  "code_information": [
    {
      "code": "0064U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 25.06,
      "maximum": 75.19,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.192,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 48.145292,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 44.9956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTEPARTUM MANIPULATION",
  "code_information": [
    {
      "code": "59412",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4039.91,
      "maximum": 9695.79,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4039.9108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4039.9108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6160.87,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5469.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5464.039,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4039.9108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9695.78592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4202.1791,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4163.4844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5049.8885,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4767.094744,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4039.9108,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4163.4844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4163.4844,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4039.9108,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Anterior asis pad",
  "code_information": [
    {
      "code": "L1250",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 38.06,
      "maximum": 38.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANTERIOR COLPORRHAPHY",
  "code_information": [
    {
      "code": "57240",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6272.25,
      "maximum": 15053.41,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6272.2534,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6272.2534,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8491.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9565.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8483.3195,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6272.2534,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15053.40816,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6493.7825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6433.9861,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7840.31675,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7401.259012,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6272.2534,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6433.9861,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6433.9861,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6272.2534,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Anterior swing band",
  "code_information": [
    {
      "code": "L2335",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 147.53,
      "maximum": 147.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 147.53,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Anterior thoracic derotation",
  "code_information": [
    {
      "code": "L1260",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 41.96,
      "maximum": 41.96,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.96,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Anterior thoracic extension",
  "code_information": [
    {
      "code": "L1220",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 139.61,
      "maximum": 139.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 139.61,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANTHRAX VACCINE SC OR IM",
  "code_information": [
    {
      "code": "90581",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 296.6,
      "maximum": 498.29,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 498.285671,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 296.604,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Anti-inhibitor",
  "code_information": [
    {
      "code": "J7198",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.28,
      "maximum": 6.31,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.09098,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.41,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.784,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.313,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.7612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.925,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.0494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.34,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Anti-Itch 0.5%-0.5% Lotion",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00536126812",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 24.78,
      "maximum": 118.0,
      "gross_charge": 118.0,
      "discounted_cash": 64.9,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 49.206,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.58,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.78,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 82.6,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 118.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.78,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 38.3736,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 43.2352,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.278,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 70.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.3,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 112.1,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 112.1,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 118.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 117.41,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 118.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 70.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.9,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 64.9,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 47.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 46.138,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38.704,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 47.672,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.648,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 115.0972,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 110.094,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 111.7224,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 106.8962,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 118.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 104.5008,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ANTI-PHOSPHOLIPID ANTIBODY",
  "code_information": [
    {
      "code": "86148",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.28,
      "maximum": 38.57,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.568,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.711115,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.0945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.28,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.07,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Anti-reflective coating",
  "code_information": [
    {
      "code": "V2750",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.33,
      "maximum": 15.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANTIBODY DETECTION NOS IF",
  "code_information": [
    {
      "code": "87299",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.1,
      "maximum": 38.64,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.758409,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.1387,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16.1,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTIBODY SARS-COV-2 TITER(S)",
  "code_information": [
    {
      "code": "0224U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 33.7,
      "maximum": 123.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 123.432,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 79.051921,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.8803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.7134,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 52.6625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33.7,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.13,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTICOAG MGMT PT WARFARIN",
  "code_information": [
    {
      "code": "93793",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.53,
      "maximum": 10.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.53,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ANTIGEN THERAPY SERVICES",
  "code_information": [
    {
      "code": "95144",
      "type": "HCPCS"
    },
    {
      "code": "95145",
      "type": "HCPCS"
    },
    {
      "code": "95146",
      "type": "HCPCS"
    },
    {
      "code": "95147",
      "type": "HCPCS"
    },
    {
      "code": "95148",
      "type": "HCPCS"
    },
    {
      "code": "95149",
      "type": "HCPCS"
    },
    {
      "code": "95165",
      "type": "HCPCS"
    },
    {
      "code": "95170",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.59,
      "maximum": 217.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.4286,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.4286,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 79.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 122.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 137.91,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 79.287,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.3125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.4286,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 140.7012,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 217.02864,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.7855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 93.4653,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.2258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 92.6047,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 73.281875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.17809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 106.705748,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 113.03575,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.4286,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.2258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 92.6047,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.2258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 92.6047,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.4286,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTINOMYCES ANTIBODY",
  "code_information": [
    {
      "code": "86602",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.05,
      "maximum": 24.43,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.432,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.654314,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.6302,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.18,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTINUCLEAR ANTIBODIES",
  "code_information": [
    {
      "code": "86038",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.63,
      "maximum": 29.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29.016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.586542,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.3706,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.63,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.09,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTINUCLEAR ANTIBODIES (ANA)",
  "code_information": [
    {
      "code": "86039",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.92,
      "maximum": 26.78,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 26.784,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.144075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.0225,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.16,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTISTREPTOLYSIN O SCREEN",
  "code_information": [
    {
      "code": "86063",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.13,
      "maximum": 13.85,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.848,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.867625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.2875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.77,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTISTREPTOLYSIN O TITER",
  "code_information": [
    {
      "code": "86060",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6.49,
      "maximum": 17.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.232325,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.4975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.49,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.3,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTITHROMBIN III ACTIVITY",
  "code_information": [
    {
      "code": "85300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10.47,
      "maximum": 28.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.20819,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.017,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.85,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.85,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTITHROMBIN III ANTIGEN",
  "code_information": [
    {
      "code": "85301",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.61,
      "maximum": 25.94,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25.944,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.623841,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.5363,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10.81,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Antithrombin recombinant",
  "code_information": [
    {
      "code": "J7196",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 143.31,
      "maximum": 458.04,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 458.041696,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 143.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 143.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 383.3542,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Antithymocyte globuln rabbit",
  "code_information": [
    {
      "code": "J7511",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 892.38,
      "maximum": 2557.33,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 999.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1153.022514,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 999.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 950.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 950.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 892.3825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 999.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1141.856,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1141.856,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2398.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2557.3267,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1009.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1009.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1128.9532,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1195.925,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1193.5381,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1009.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1009.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 956.74,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTMC GUIDE 3D PRINT 1ST GD",
  "code_information": [
    {
      "code": "0561T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.47,
      "maximum": 181.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 115.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 102.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 102.068,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 181.13664,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 89.058848,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ANTMC MDL 3D PRINT 1ST CMPNT",
  "code_information": [
    {
      "code": "0559T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.47,
      "maximum": 181.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 115.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 102.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 102.068,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 181.13664,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 89.058848,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Anusol-Hc 2.5% Cream",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "65649040130",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 73.29,
      "maximum": 349.0,
      "gross_charge": 349.0,
      "discounted_cash": 191.95,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 145.533,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 108.19,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 73.29,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 244.3,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 349.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 73.29,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 127.8736,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 113.4948,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 216.729,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 209.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 122.15,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 331.55,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 331.55,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 349.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 347.255,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 349.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 191.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 191.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 139.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 136.459,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 114.472,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 140.996,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 117.264,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 340.4146,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 325.617,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 330.4332,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 316.1591,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 349.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 309.0744,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Anusol-Hc 25 MG Suppository",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "65649041112",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22.0,
      "maximum": 104.75,
      "gross_charge": 104.75,
      "discounted_cash": 57.61,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43.68075,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.4725,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.9975,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 73.325,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 104.75,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21.9975,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 38.3804,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.0647,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.6625,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.04975,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 62.85,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.5125,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 99.5125,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 104.75,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 104.22625,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 104.75,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 62.85,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.6125,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.6125,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.9,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.95725,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 34.358,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 42.319,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 35.196,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 102.17315,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 97.73175,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 99.1773,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 94.893025,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 104.75,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.7666,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC",
  "code_information": [
    {
      "code": "268",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10861.0,
      "maximum": 142118.05,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72844.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66208.68,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to additional per diem in excess of included days",
          "standard_charge_dollar": 10861.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "per diem"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66208.68,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 142118.0477,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126175.0755,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 81282.6745,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66208.68,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 115656.0,
          "standard_charge_algorithm": "Can be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 114698.336444,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 54773.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 54773.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to additional per diem in excess of included days, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 14428.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "per diem"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to additional per diem in excess of included days, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 18925.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "per diem"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66208.68,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66208.68,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 79349.7125,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74906.1286,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 63479.77,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 66208.68,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 67511.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 63479.77,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 65546.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 72828.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 64089.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC",
  "code_information": [
    {
      "code": "269",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 10861.0,
      "maximum": 115656.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72844.0,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40837.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to additional per diem in excess of included days",
          "standard_charge_dollar": 10861.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "per diem"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40837.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 77474.604,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 87263.9816,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 50721.8205,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 115656.0,
          "standard_charge_algorithm": "Can be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40837.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 70427.603552,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 54773.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 54773.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to additional per diem in excess of included days, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 14428.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "per diem"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to additional per diem in excess of included days, Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 18925.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "per diem"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40837.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40837.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46907.9382,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49690.6125,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39752.49,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 40837.64,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 67511.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39752.49,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 65546.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 72828.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions , Can be subject to separate per diem based on day of stay",
          "standard_charge_dollar": 64089.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisionsCan be subject to separate per diem based on day of stay",
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AORTIC DYSFUNCTION/DILATION",
  "code_information": [
    {
      "code": "81410",
      "type": "HCPCS"
    },
    {
      "code": "81411",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 504.0,
      "maximum": 3240.46,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 504.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1350.19,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 504.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1350.19,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 504.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1350.19,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1209.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3240.456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 774.67572,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2075.308014,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 723.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1939.5402,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 504.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1350.19,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 504.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1350.19,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 504.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1350.19,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 504.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1350.19,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APC GENE DUP/DELET VARIANTS",
  "code_information": [
    {
      "code": "81203",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.0,
      "maximum": 480.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 480.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 307.411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 287.3,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 160.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APC GENE FULL SEQUENCE",
  "code_information": [
    {
      "code": "81201",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 599.94,
      "maximum": 1872.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 780.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 780.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 780.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1872.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1198.9029,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1120.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 780.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 780.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 599.94,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 780.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 780.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APC GENE KNOWN FAM VARIANTS",
  "code_information": [
    {
      "code": "81202",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.15,
      "maximum": 672.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 672.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 430.3754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 402.22,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 280.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APC MRNA SEQ ALYS",
  "code_information": [
    {
      "code": "0157U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 282.88,
      "maximum": 678.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 678.912,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 434.797389,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 406.3527,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 282.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.88,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.88,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apexification/recalc final",
  "code_information": [
    {
      "code": "D3353",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apexification/recalc initial",
  "code_information": [
    {
      "code": "D3351",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apexification/recalc interim",
  "code_information": [
    {
      "code": "D3352",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHAKIA PROSTH SERVICE TEMP",
  "code_information": [
    {
      "code": "92358",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.47,
      "maximum": 181.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 102.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 115.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 102.068,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 181.13664,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 76.5791,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.8739,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 89.058848,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.8739,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.8739,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHERESIS IMMUNOADS SLCTV",
  "code_information": [
    {
      "code": "36516",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5601.9,
      "maximum": 14287.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5952.977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5952.977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9078.31,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8059.51,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8051.497,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5952.977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14287.1448,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5653.9667,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5601.9036,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7024.51286,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7441.22125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5952.977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5601.9036,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5601.9036,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5952.977,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHERESIS PLASMA",
  "code_information": [
    {
      "code": "36514",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2003.11,
      "maximum": 4998.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3176.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2819.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2817.1205,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4998.88608,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2021.7279,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2003.1113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2603.5865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2457.785656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2003.1113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2003.1113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHERESIS PLATELETS",
  "code_information": [
    {
      "code": "36513",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 555.48,
      "maximum": 1333.15,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 555.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 555.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 752.04,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 847.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 751.2885,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 555.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1333.15416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 572.6975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 567.424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 655.467462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 694.351125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 555.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 567.424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 567.424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 555.4809,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHERESIS RBC",
  "code_information": [
    {
      "code": "36512",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2003.11,
      "maximum": 4998.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3176.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2819.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2817.1205,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4998.88608,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2021.7279,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2003.1113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2457.785656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2603.5865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2003.1113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2003.1113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APHERESIS WBC",
  "code_information": [
    {
      "code": "36511",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2003.11,
      "maximum": 4998.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2819.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3176.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2817.1205,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4998.88608,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2021.7279,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2003.1113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2457.785656,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2603.5865,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2003.1113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2003.1113,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2082.8692,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apically positioned flap",
  "code_information": [
    {
      "code": "D4245",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1882.11,
      "maximum": 4517.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2548.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2870.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2545.601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4517.07456,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2014.1424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2352.643,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2220.894992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1995.5957,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1882.1144,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apicoectomy - anterior",
  "code_information": [
    {
      "code": "D3410",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 831.49,
      "maximum": 5070.09,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2860.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3221.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2857.239,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5070.09048,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 839.2186,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2492.794486,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2640.672125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 831.4909,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2112.5377,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apis, per square centimeter",
  "code_information": [
    {
      "code": "A2010",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apligraf",
  "code_information": [
    {
      "code": "Q4101",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 30.36,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 161.41097,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 81.9352,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "APOL1 RISK VARIANTS",
  "code_information": [
    {
      "code": "0355U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 137.0,
      "maximum": 328.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 328.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 210.576535,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 196.8005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apollo ft per sq cm",
  "code_information": [
    {
      "code": "Q4385",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Apomorphine hydrochloride",
  "code_information": [
    {
      "code": "J0364",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14.31,
      "maximum": 94.72,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.313803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35.411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35.411,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 94.7217,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "APP MDLTY 1+CNTRST BTH EA 15",
  "code_information": [
    {
      "code": "97034",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.83,
      "maximum": 41.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.688,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.82,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APP MDLTY 1+HUBBRD TNK EA 15",
  "code_information": [
    {
      "code": "97036",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.14,
      "maximum": 110.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 45.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 110.136,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.68,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APP MDLTY 1+IONTPHRSIS EA 15",
  "code_information": [
    {
      "code": "97033",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9.18,
      "maximum": 57.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 57.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.27,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APP MDLTY 1+ULTRASOUND EA 15",
  "code_information": [
    {
      "code": "97035",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.43,
      "maximum": 42.53,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.528,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.18,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APP MLTPLN UNI XTRNL FIX 1ST",
  "code_information": [
    {
      "code": "20696",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 23366.4,
      "maximum": 56079.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31634.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35633.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31603.422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56079.354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35223.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29207.996875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27572.34905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APP MLTPLN UNI XTRNL FIX XCH",
  "code_information": [
    {
      "code": "20697",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2033.48,
      "maximum": 4880.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3101.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2753.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2750.326,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4880.35416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2087.3671,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2541.851125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2399.507462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APP SKN CL SSP AGRFT T/A/L 1",
  "code_information": [
    {
      "code": "15015",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2324.22,
      "maximum": 5578.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3146.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3544.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3143.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5578.12704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2678.3867,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.7234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2905.2745,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2742.579128,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.7234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.7234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APP SKN CLL SSP F/N/G/HF 1ST",
  "code_information": [
    {
      "code": "15017",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2324.22,
      "maximum": 5578.13,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3544.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3146.67,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3143.55,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5578.12704,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2678.3867,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.7234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2742.579128,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2905.2745,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.7234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2653.7234,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2324.2196,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APP TOPICAL FLUORIDE VARNISH",
  "code_information": [
    {
      "code": "99188",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 18.0,
      "maximum": 18.0,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "APPENDECTOMY",
  "code_information": [
    {
      "code": "44950",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7928.23,
      "maximum": 19027.74,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7928.2264,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7928.2264,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12090.57,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10733.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10723.0585,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7928.2264,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19027.74336,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8403.7992,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8326.415,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9355.307152,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9910.283,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7928.2264,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8326.415,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8326.415,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7928.2264,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Appendix Procedures with MCC",
  "code_information": [
    {
      "code": "397",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 23364.53,
      "maximum": 49485.82,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23364.53,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23364.53,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 43934.4405,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 49485.8187,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 30206.105,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23364.53,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39938.214564,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23364.53,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23364.53,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29780.25,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28112.556,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23824.2,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23364.53,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23824.2,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPENDIX PROCEDURES WITHOUT CC/MCC",
  "code_information": [
    {
      "code": "399",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11008.88,
      "maximum": 23652.94,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11416.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11416.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23652.9361,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20999.5215,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13699.9025,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11416.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19089.429292,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11416.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11416.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13761.1,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12990.4784,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11008.88,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11416.33,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11008.88,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Appendix Procedures without MCC/CC",
  "code_information": [
    {
      "code": "398",
      "type": "MS-DRG"
    }
  ],
  "standard_charges": [
    {
      "minimum": 14694.47,
      "maximum": 31275.52,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31275.5168,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27766.992,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 25241.338496,
          "count": "0",
          "methodology": "case rate"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available., This code and the associated base rate is considered to be an all inclusive rate which may include additional clinical services",
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "APPL BDY CST SHO TO HIP 1THI",
  "code_information": [
    {
      "code": "29044",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL BDY CST SHO TO HIP B TH",
  "code_information": [
    {
      "code": "29046",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL BDY CST SHO TO HIP HEAD",
  "code_information": [
    {
      "code": "29040",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL BODY CAST SHO TO HIPS",
  "code_information": [
    {
      "code": "29035",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL CAST FIGURE-OF-EIGHT",
  "code_information": [
    {
      "code": "29049",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL CAST HAND&LWR FOREARM",
  "code_information": [
    {
      "code": "29085",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL CAST PLASTER VELPEAU",
  "code_information": [
    {
      "code": "29058",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL CAST SHOULDER SPICA",
  "code_information": [
    {
      "code": "29055",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL CST ELBW FNGR SHORT ARM",
  "code_information": [
    {
      "code": "29075",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL CST SHO TO HAND LNG ARM",
  "code_information": [
    {
      "code": "29065",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL CYLINDER CAST",
  "code_information": [
    {
      "code": "29365",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL FINGER SPLINT DYNAMIC",
  "code_information": [
    {
      "code": "29131",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.47,
      "maximum": 181.14,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 102.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 115.09,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 102.068,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 181.13664,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 76.5791,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.8739,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 89.058848,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 94.342,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.8739,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.8739,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 75.4736,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL FINGER SPLINT STATIC",
  "code_information": [
    {
      "code": "29130",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 163.78,
      "maximum": 393.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 249.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.521,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 393.07272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 193.260754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.725375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL HALO CRANIAL 6+PINS",
  "code_information": [
    {
      "code": "20664",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2068.15,
      "maximum": 2087.37,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2087.3671,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL HALO TYPE BODY CAST",
  "code_information": [
    {
      "code": "29000",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL HIP SPICA CAST 1 LEG",
  "code_information": [
    {
      "code": "29305",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL HIP SPICA CAST1&1/2",
  "code_information": [
    {
      "code": "29325",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL LONG LEG CAST BRACE",
  "code_information": [
    {
      "code": "29358",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL LONG LEG CAST WALKER",
  "code_information": [
    {
      "code": "29355",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL MLTLAY CMPRN SYS UP ARM",
  "code_information": [
    {
      "code": "29584",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL MLTPLN UNI EXT FIXJ SYS",
  "code_information": [
    {
      "code": "20692",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL MODALITY 1+ESTIM EA 15",
  "code_information": [
    {
      "code": "97032",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.66,
      "maximum": 44.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 18.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 44.688,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.66,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.11,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.11,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL MODALITY 1+LLLT PO PAIN",
  "code_information": [
    {
      "code": "97037",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 48.04,
      "maximum": 119.69,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 67.52,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 76.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 67.4595,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 119.69064,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.4861,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.847898,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 62.338875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 48.0396,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 49.8711,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL MULTLAYER CMPRN SYS LEG",
  "code_information": [
    {
      "code": "29581",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL PATLLR TDN BEARING CAST",
  "code_information": [
    {
      "code": "29435",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL RIGID TOT CNTC LEG CAST",
  "code_information": [
    {
      "code": "29445",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL RISSER JACKET BODY ONLY",
  "code_information": [
    {
      "code": "29010",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL RISSR JACKET BDY W/HEAD",
  "code_information": [
    {
      "code": "29015",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL SHORT ARM SPLINT DYN",
  "code_information": [
    {
      "code": "29126",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 163.78,
      "maximum": 393.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 249.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.521,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 393.07272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.725375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 193.260754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL SHORT ARM SPLINT STATIC",
  "code_information": [
    {
      "code": "29125",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 163.78,
      "maximum": 393.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 249.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 221.74,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 221.521,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 393.07272,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.7127,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 193.260754,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 204.725375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 171.1223,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.7803,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL SHORT LEG CAST",
  "code_information": [
    {
      "code": "29405",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL SHORT LEG CAST WALKING",
  "code_information": [
    {
      "code": "29425",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPL UNIPLN UNI EXT FIXJ SYS",
  "code_information": [
    {
      "code": "20690",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATION CAST FINGER",
  "code_information": [
    {
      "code": "29086",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATION CLUBFOOT CAST",
  "code_information": [
    {
      "code": "29450",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATION HALO CRANIAL",
  "code_information": [
    {
      "code": "20661",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2068.15,
      "maximum": 2087.37,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2087.3671,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATION HALO FEMORAL",
  "code_information": [
    {
      "code": "20663",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATION HALO PELVIC",
  "code_information": [
    {
      "code": "20662",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2033.48,
      "maximum": 4880.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2753.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3101.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2750.326,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4880.35416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2087.3671,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2541.851125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2399.507462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATION LONG ARM SPLINT",
  "code_information": [
    {
      "code": "29105",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATION LONG LEG SPLINT",
  "code_information": [
    {
      "code": "29505",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATION OF LONG LEG CAST",
  "code_information": [
    {
      "code": "29345",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 337.45,
      "maximum": 809.87,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 514.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 456.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.399,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 809.87016,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 363.074,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 421.807375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.186162,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 359.7307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 337.4459,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATION SHORT LEG SPLINT",
  "code_information": [
    {
      "code": "29515",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 200.49,
      "maximum": 481.17,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 271.44,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 305.75,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 271.168,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 481.1712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 210.945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 250.61,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 236.57584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 209.0026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 200.488,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLICATON ON-BODY INJECTOR",
  "code_information": [
    {
      "code": "96377",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 58.63,
      "maximum": 140.7,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 79.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 89.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 79.287,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 140.7012,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.7855,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.2258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 73.281875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 69.17809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.2258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 60.2258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 58.6255,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLY INTERSTIT RADIAT COMPL",
  "code_information": [
    {
      "code": "77778",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 734.59,
      "maximum": 2115.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1344.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1193.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1192.307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2115.732,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 904.1081,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 895.7829,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1040.2349,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1101.94375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 734.59,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 895.7829,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 895.7829,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLY INTRCAV RADIAT COMPL",
  "code_information": [
    {
      "code": "77763",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 603.48,
      "maximum": 2115.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1344.37,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1193.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1192.307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2115.732,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 904.1081,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 895.7829,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1040.2349,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1101.94375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 603.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 895.7829,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 895.7829,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 881.555,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLY INTRCAV RADIAT INTERM",
  "code_information": [
    {
      "code": "77762",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 427.42,
      "maximum": 1764.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1120.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 995.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 994.1085,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1764.0096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 717.2664,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 710.6616,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 867.30472,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 918.755,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 427.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 710.6616,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 710.6616,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLY INTRCAV RADIAT SIMPLE",
  "code_information": [
    {
      "code": "77761",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 322.48,
      "maximum": 1764.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 995.1,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1120.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 994.1085,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1764.0096,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 717.2664,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 710.6616,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 918.755,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 867.30472,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 322.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 710.6616,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 710.6616,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 735.004,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLY REM FIXATION DEVICE",
  "code_information": [
    {
      "code": "20660",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2033.48,
      "maximum": 4880.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2753.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3101.07,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2750.326,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4880.35416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2087.3671,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2399.507462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2541.851125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2068.1461,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2033.4809,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "APPLY SURF LDR RADIONUCLIDE",
  "code_information": [
    {
      "code": "77789",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 106.73,
      "maximum": 333.91,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.1307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.1307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 212.17,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 188.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 188.176,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.1307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 333.91368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 132.4473,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.2277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 173.913375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 164.174226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 106.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.1307,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.2277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.2277,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 139.1307,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aprotonin, 10,000 kiu",
  "code_information": [
    {
      "code": "J0365",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 7.09,
      "maximum": 10.05,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.050117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.0887,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "AQAPRN-4 ANTB FLO CYTMTRY EA",
  "code_information": [
    {
      "code": "86053",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.05,
      "maximum": 90.55,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 90.552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.982444,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 54.1892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.73,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AQMBF PET REST & RX STRESS",
  "code_information": [
    {
      "code": "78434",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 27.03,
      "maximum": 27.03,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 27.03,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Aquaphor 41% Healing Ointment",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "72140045231",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.74,
      "maximum": 41.64,
      "gross_charge": 41.64,
      "discounted_cash": 22.9,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.36388,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.9084,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.7444,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 29.148,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 41.64,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.7444,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.256896,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13.541328,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 25.85844,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 24.984,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.574,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.558,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 39.558,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 41.4318,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 41.64,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 41.64,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 24.984,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.902,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22.902,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.656,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.28124,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.65792,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.82256,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.99104,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 40.615656,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 38.85012,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 39.424752,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 37.721676,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 41.64,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 36.876384,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "AQUAPORIN-4 ANTB CBA EACH",
  "code_information": [
    {
      "code": "86052",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.05,
      "maximum": 28.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.515601,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.3043,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AQUAPORIN-4 ANTB ELISA",
  "code_information": [
    {
      "code": "86051",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.53,
      "maximum": 27.67,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27.672,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.711603,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.5529,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.53,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.53,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AQUATIC THERAPY/EXERCISES",
  "code_information": [
    {
      "code": "97113",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.93,
      "maximum": 112.73,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 46.97,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 112.728,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.84,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.84,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.93,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.84,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.84,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AQUEOUS SHUNT EYE W/GRAFT",
  "code_information": [
    {
      "code": "66180",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6555.93,
      "maximum": 15734.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9997.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8875.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8866.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15734.226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6907.6931,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.0854,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7735.99445,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8194.909375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.0854,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.0854,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AQUEOUS SHUNT EYE W/O GRAFT",
  "code_information": [
    {
      "code": "66179",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6555.93,
      "maximum": 15734.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8875.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9997.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8866.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15734.226,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6907.6931,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.0854,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7735.99445,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8194.909375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.0854,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6844.0854,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6555.9275,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AR FULL SEQUENCE ANALYSIS",
  "code_information": [
    {
      "code": "0230U",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 301.35,
      "maximum": 723.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 723.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 463.197436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 432.8948,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AR GENE CHARAC ALLELES",
  "code_information": [
    {
      "code": "81204",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 109.6,
      "maximum": 328.8,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 328.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 210.576535,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 196.8005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 109.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 137.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AR GENE FULL GENE SEQUENCE",
  "code_information": [
    {
      "code": "81173",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 241.08,
      "maximum": 723.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 723.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 463.197436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 432.8948,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 241.08,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "AR GENE KNOWN FAMIL VARIANT",
  "code_information": [
    {
      "code": "81174",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 148.16,
      "maximum": 444.48,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 185.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 185.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 185.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 444.48,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 284.662586,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 266.0398,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 185.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 185.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 148.16,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 185.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 185.2,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Arava 20 MG Tablet",
  "drug_information": {
    "unit": 20.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00088216130",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 5.52,
      "maximum": 26.29,
      "gross_charge": 26.29,
      "discounted_cash": 14.46,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.96293,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.1499,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.5209,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.403,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.29,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.5209,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9.632656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.549508,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 16.32609,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 15.774,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.2015,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.9755,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.9755,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.29,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.15855,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.29,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.774,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.4595,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 14.4595,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.516,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.27939,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.62312,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.62116,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.83344,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 25.643266,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.52857,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 24.891372,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.816111,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 26.29,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 23.282424,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Arbutamine hcl injection",
  "code_information": [
    {
      "code": "J0395",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 428.0,
      "maximum": 835.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 835.377907,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 428.0,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Architect ecm px fx 1 sq cm",
  "code_information": [
    {
      "code": "Q4147",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 393.81,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 223.843515,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 393.8135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ardeograft, per sq cm",
  "code_information": [
    {
      "code": "Q4333",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 2046.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2046.375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Arformoterol non-comp unit",
  "code_information": [
    {
      "code": "J7605",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.38,
      "maximum": 22.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.536626,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.9055,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.65,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Argatroban 250 MG/2.5 Ml Vial",
  "drug_information": {
    "unit": 250.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00143928801",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 3469.0,
      "gross_charge": 3469.0,
      "discounted_cash": 1907.95,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 1134.363,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 728.49,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2428.3,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3469.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 728.49,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1128.1188,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1271.0416,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2154.249,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2081.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1214.15,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 860.312,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 860.312,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3469.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3451.655,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3469.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2081.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1907.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1907.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1387.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1356.379,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1137.832,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1165.584,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1401.476,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3383.6626,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3236.577,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3284.4492,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3142.5671,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3469.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3072.1464,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Argatroban dialysis (accord)",
  "code_information": [
    {
      "code": "J0892",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.04,
      "maximum": 18.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.577489,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.0375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.0375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.83,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Argatroban dialysis, auromed",
  "code_information": [
    {
      "code": "J0899",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.98,
      "maximum": 18.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.27294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.978,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.978,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.6465,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.36,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Argatroban esrd dialysis 1mg",
  "code_information": [
    {
      "code": "J0884",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2.36,
      "maximum": 21.32,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.31843,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.363,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.363,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.5497,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.33,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Argatroban nonesrd (accord)",
  "code_information": [
    {
      "code": "J0891",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.73,
      "maximum": 18.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.577489,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.729,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.0375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.0375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.368,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.807,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.83,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.3125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.2,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Argatroban nonesrd (auromed)",
  "code_information": [
    {
      "code": "J0898",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.27,
      "maximum": 18.27,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.27294,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.273,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.978,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.978,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.62,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.888,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.6465,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.7582,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.8625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.7026,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.49,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Argatroban-NaCl 50 MG/50 Ml Vl",
  "drug_information": {
    "unit": 50.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "42367020307",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 2141.0,
      "gross_charge": 2141.0,
      "discounted_cash": 1177.55,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 700.107,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.31843,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2141.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 0.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.9025,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1329.561,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.363,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2.363,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.92,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 530.968,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 530.968,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2141.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2130.295,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2141.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.4868,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.575,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.33,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.2071,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 837.131,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 702.248,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 864.964,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 719.376,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.6,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2088.3314,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1997.553,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 2027.0988,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1939.5319,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 2141.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1896.0696,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARHFCMRIGTBS 1ST TX DAY",
  "code_information": [
    {
      "code": "0890T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3562.98,
      "maximum": 11436.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3750.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3750.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3562.975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11436.92472,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4721.5045,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5956.731625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5623.154654,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4721.5045,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4721.5045,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARHFCMRIGTBS SBSQ PER TX DAY",
  "code_information": [
    {
      "code": "0892T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3562.98,
      "maximum": 11436.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3750.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3750.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3562.975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11436.92472,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4721.5045,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5623.154654,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5956.731625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4721.5045,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4721.5045,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARHFCMRIGTBS SBSQ TX DAY",
  "code_information": [
    {
      "code": "0891T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3562.98,
      "maximum": 11436.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3750.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3750.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3562.975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11436.92472,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4721.5045,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5623.154654,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5956.731625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4721.5045,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4721.5045,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4765.3853,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aricept 5 MG Tablet",
  "drug_information": {
    "unit": 5.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "62856024530",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 19.5,
      "maximum": 92.88,
      "gross_charge": 92.88,
      "discounted_cash": 51.08,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 38.73096,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.7928,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.5048,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 65.016,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 92.88,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.5048,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 34.031232,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 30.204576,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.508,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 57.67848,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 55.728,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.236,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 88.236,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.4156,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.88,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.88,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 55.728,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.084,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 51.084,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.152,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.31608,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 30.46464,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 37.52352,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 31.20768,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 90.595152,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 86.65704,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 87.938784,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 84.139992,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 92.88,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 82.254528,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aripiprazole 20 MG Tablet",
  "drug_information": {
    "unit": 20.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "60505267603",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 114.66,
      "maximum": 546.0,
      "gross_charge": 546.0,
      "discounted_cash": 300.3,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 227.682,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 169.26,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 114.66,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 382.2,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 546.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 114.66,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 177.5592,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 200.0544,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 339.066,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 327.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 191.1,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 518.7,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 518.7,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 546.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 543.27,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 546.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 327.6,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.3,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 300.3,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 218.4,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 213.486,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 179.088,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 220.584,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 183.456,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 532.5684,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 509.418,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 516.9528,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 494.6214,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 546.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 483.5376,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aripiprazole 5 MG Tablet",
  "drug_information": {
    "unit": 5.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00904651006",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 85.05,
      "maximum": 405.0,
      "gross_charge": 405.0,
      "discounted_cash": 222.75,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 168.885,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 125.55,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 85.05,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 283.5,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 405.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 85.05,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 131.706,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 148.392,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 251.505,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 243.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 141.75,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 384.75,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 384.75,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 405.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 402.975,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 405.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 243.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 222.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 222.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 162.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 158.355,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 132.84,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 163.62,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 136.08,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 395.037,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 377.865,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 383.454,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 366.8895,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 405.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 358.668,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aripiprazole injection",
  "code_information": [
    {
      "code": "J0400",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1.52,
      "maximum": 5.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.522745,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.0062,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 5.22,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Aripiprazole lauroxil 1 mg",
  "code_information": [
    {
      "code": "J1944",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.1,
      "maximum": 14.62,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.618352,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.23,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.097,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.6805,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.6805,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.04,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.6135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.34,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.34,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.8114,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.0375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.57,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.1422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.34,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.34,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.23,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aripiprazole lauroxil 1mg",
  "code_information": [
    {
      "code": "J1942",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 11.57,
      "maximum": 11.57,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11.572862,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Arixtra 10 MG/0.8 Ml Syringe",
  "drug_information": {
    "unit": 10.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "67457059508",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 732.0,
      "gross_charge": 732.0,
      "discounted_cash": 402.6,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 239.364,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 153.72,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 512.4,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 732.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 153.72,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 268.2048,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 238.0464,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 454.572,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 439.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 256.2,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.536,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 181.536,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 732.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 728.34,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 732.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 439.2,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 402.6,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 402.6,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 292.8,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 286.212,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 240.096,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 295.728,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 245.952,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 713.9928,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 682.956,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 693.0576,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 663.1188,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 732.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 648.2592,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Arm pad repl, each",
  "code_information": [
    {
      "code": "K0019",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.51,
      "maximum": 15.51,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.51,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Arm supp att to wc rancho ty",
  "code_information": [
    {
      "code": "E2627",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 1064.58,
      "maximum": 1064.58,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1064.58,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Arm trough each",
  "code_information": [
    {
      "code": "E2209",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 95.89,
      "maximum": 95.89,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 95.89,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Armour Thyroid 60 MG Tablet",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "00456045901",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 12.29,
      "maximum": 58.51,
      "gross_charge": 58.51,
      "discounted_cash": 32.18,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.39867,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.1381,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.2871,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 40.957,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.2871,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 19.027452,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.438064,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 36.33471,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 35.106,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20.4785,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.5845,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 55.5845,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.21745,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35.106,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.1805,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32.1805,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.404,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.87741,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.19128,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.63804,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 19.65936,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 57.070654,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 54.58983,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53.004209,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 55.397268,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 58.51,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 51.816456,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Aromasin 25 MG Tablet",
  "drug_information": {
    "unit": 25.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00009766304",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 385.0,
      "gross_charge": 385.0,
      "discounted_cash": 211.75,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 125.895,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 80.85,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 269.5,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 385.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 80.85,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 141.064,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 125.202,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 239.085,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 231.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 134.75,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 95.48,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 95.48,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 385.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 383.075,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 385.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 231.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 211.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 211.75,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 154.0,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 150.535,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 126.28,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 155.54,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 129.36,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 375.529,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 359.205,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 364.518,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 348.7715,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 385.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 340.956,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Arsenic Trioxide 10 MG/10 Ml Vl",
  "drug_information": {
    "unit": 10.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "69918072001",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.47,
      "maximum": 53820.0,
      "gross_charge": 53820.0,
      "discounted_cash": 29601.0,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 10796.0,
          "standard_charge_percentage": 32.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold",
          "standard_charge_dollar": 23034.96,
          "standard_charge_percentage": 42.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 53820.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4.68,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.5505,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.15,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.796,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 33422.22,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 33.796,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13347.36,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4808,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13347.36,
          "standard_charge_percentage": 24.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Svc. May be packaged/bundled into a separate rate or paid at a % of charge if it exceeds the contractual threshold Can be subject to stoploss provisions",
          "standard_charge_dollar": 0.4708,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 53820.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53550.9,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53820.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 32292.0,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8.496,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9.0,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.96,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6.0862,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21043.62,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17652.96,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21743.28,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18083.52,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 52496.028,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 50214.06,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.2,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 50956.776,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 48755.538,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 53820.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47662.992,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ART PRESSURE WAVEFORM ANALYS",
  "code_information": [
    {
      "code": "93050",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 15.38,
      "maximum": 74.68,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 42.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 47.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 42.0945,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 74.6808,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.5462,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 38.89625,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.71806,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 37.2005,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31.117,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Artacent ac 1 sq cm",
  "code_information": [
    {
      "code": "Q4190",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 3805.95,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3805.948853,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 840.7525,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Artacent ac, 1 mg",
  "code_information": [
    {
      "code": "Q4189",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 56.9,
      "maximum": 56.9,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 56.8972,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Artacent cord per sq cm",
  "code_information": [
    {
      "code": "Q4216",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Artacent velos, per sq cm",
  "code_information": [
    {
      "code": "Q4338",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Artacent vericlen, per sq cm",
  "code_information": [
    {
      "code": "Q4339",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Artacent wound, per sq cm",
  "code_information": [
    {
      "code": "Q4169",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 1855.92,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1855.921606,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1077.7575,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Artecent c, per sq cm",
  "code_information": [
    {
      "code": "Q4336",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Artecent trident, per sq cm",
  "code_information": [
    {
      "code": "Q4337",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAY EACH VESSEL",
  "code_information": [
    {
      "code": "75774",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 75.52,
      "maximum": 75.52,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 75.52,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ARTERY X-RAYS ABDOMEN",
  "code_information": [
    {
      "code": "75726",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 130.26,
      "maximum": 20165.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9298.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10474.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9289.7365,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16484.35776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20165.64759,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18881.6925,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7223.3737,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8104.809232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8585.603,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 130.26,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAYS ADRENAL GLAND",
  "code_information": [
    {
      "code": "75731",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 139.47,
      "maximum": 11696.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6098.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5414.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5408.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9598.1124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11696.74935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10952.0125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4098.7904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4999.016875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4719.07193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 139.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAYS ADRENALS",
  "code_information": [
    {
      "code": "75733",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 154.79,
      "maximum": 11696.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5414.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6098.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5408.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9598.1124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11696.74935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10952.0125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4098.7904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4999.016875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4719.07193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 154.79,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAYS ARM/LEG",
  "code_information": [
    {
      "code": "75710",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 136.14,
      "maximum": 11696.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5414.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6098.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5408.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9598.1124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11696.74935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10952.0125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4098.7904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4719.07193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4999.016875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 136.14,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAYS ARMS/LEGS",
  "code_information": [
    {
      "code": "75716",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 146.99,
      "maximum": 11696.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5414.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6098.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5408.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9598.1124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11696.74935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10952.0125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4098.7904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4999.016875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4719.07193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 146.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAYS CHEST",
  "code_information": [
    {
      "code": "75756",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 145.39,
      "maximum": 11696.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5414.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6098.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5408.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9598.1124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11696.74935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10952.0125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4098.7904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4999.016875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4719.07193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 145.39,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAYS LUNG",
  "code_information": [
    {
      "code": "75741",
      "type": "HCPCS"
    },
    {
      "code": "75746",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 119.03,
      "maximum": 11696.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5414.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6098.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5408.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9598.1124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11696.74935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10952.0125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4098.7904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4719.07193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4999.016875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 119.03,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 122.77,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAYS LUNGS",
  "code_information": [
    {
      "code": "75743",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 134.54,
      "maximum": 11696.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6098.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5414.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5408.996,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9598.1124,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 11696.74935,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10952.0125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4098.7904,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4999.016875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4719.07193,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 134.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4061.0477,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3999.2135,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAYS PELVIS",
  "code_information": [
    {
      "code": "75736",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 129.35,
      "maximum": 20165.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10474.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9298.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9289.7365,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16484.35776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20165.64759,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18881.6925,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7223.3737,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8585.603,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8104.809232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 129.35,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY X-RAYS SPINE",
  "code_information": [
    {
      "code": "75705",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 211.36,
      "maximum": 20165.65,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9298.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10474.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9289.7365,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16484.35776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 20165.64759,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18881.6925,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7223.3737,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8104.809232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8585.603,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 211.36,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY-VEIN AUTOGRAFT",
  "code_information": [
    {
      "code": "36825",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6868.48,
      "maximum": 16484.36,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10474.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9298.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9289.7365,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16484.35776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7223.3737,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8585.603,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8104.809232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTERY-VEIN NONAUTOGRAFT",
  "code_information": [
    {
      "code": "36830",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 6868.48,
      "maximum": 16484.36,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 9298.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 10474.46,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9289.7365,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16484.35776,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7223.3737,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8585.603,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 8104.809232,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7156.8591,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 6868.4824,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHR ANK OSTCHN DF TAL&/TIB",
  "code_information": [
    {
      "code": "29891",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHR SI JT OPN B1GRF INSTRM",
  "code_information": [
    {
      "code": "27280",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ANT DFRM 2-3 VRT SGM",
  "code_information": [
    {
      "code": "22808",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ANT DFRM 4-7 VRT SGM",
  "code_information": [
    {
      "code": "22810",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ANT DFRM 8+ VRT SGM",
  "code_information": [
    {
      "code": "22812",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ANT NTRBD MIN DSC CRV",
  "code_information": [
    {
      "code": "22554",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ANT NTRBD MIN DSC LUM",
  "code_information": [
    {
      "code": "22558",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 34898.89,
      "maximum": 35223.23,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35223.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ANT NTRBD MIN DSC THC",
  "code_information": [
    {
      "code": "22556",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ANT NTRBDY CERVICAL",
  "code_information": [
    {
      "code": "22551",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 25795.0,
          "count": "0",
          "methodology": "case rate"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ANT TORAL/XORAL C1-C2",
  "code_information": [
    {
      "code": "22548",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16512.69,
      "maximum": 16666.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD CMBN 1NTRSPC LUMBAR",
  "code_information": [
    {
      "code": "22633",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 23366.4,
      "maximum": 56079.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35633.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31634.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31603.422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56079.354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35223.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29207.996875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27572.34905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD DST RAD/UL JT SGM RSC",
  "code_information": [
    {
      "code": "25830",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD ELBOW JT AUTOG GRAFT",
  "code_information": [
    {
      "code": "24802",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD GLENOHUMERAL JT W/GRF",
  "code_information": [
    {
      "code": "23802",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD HIP JT SBTRCHC OSTEOT",
  "code_information": [
    {
      "code": "27286",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16512.69,
      "maximum": 16666.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD LAT XTRCVTRY TQ LMBR",
  "code_information": [
    {
      "code": "22533",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD LAT XTRCVTRY TQ THRC",
  "code_information": [
    {
      "code": "22532",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16512.69,
      "maximum": 16666.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PRE-SAC NTRBDY L5-S1",
  "code_information": [
    {
      "code": "22586",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PST DFRM 13+ VRT SGM",
  "code_information": [
    {
      "code": "22804",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PST DFRM 7-12 VRT SGM",
  "code_information": [
    {
      "code": "22802",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PST DFRM<6 VRT SGM",
  "code_information": [
    {
      "code": "22800",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PST TQ 1NTRSPC CRV",
  "code_information": [
    {
      "code": "22600",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PST TQ 1NTRSPC LUM",
  "code_information": [
    {
      "code": "22630",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 23366.4,
      "maximum": 56079.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35633.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31634.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31603.422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56079.354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 35223.2301,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29207.996875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27572.34905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 34898.8859,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PST TQ 1NTRSPC LUMBAR",
  "code_information": [
    {
      "code": "22612",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 56079.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31634.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35633.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31603.422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56079.354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27572.34905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29207.996875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PST TQ 1NTRSPC THRC",
  "code_information": [
    {
      "code": "22610",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 22761.01,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PST TQ ATLAS-AXIS",
  "code_information": [
    {
      "code": "22595",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16512.69,
      "maximum": 16666.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD PST TQ CRANIOCERVICAL",
  "code_information": [
    {
      "code": "22590",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16512.69,
      "maximum": 16666.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD SI JT PLMT IARTIC DEV",
  "code_information": [
    {
      "code": "27278",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 56079.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31634.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35633.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31603.422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56079.354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27572.34905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29207.996875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD SI JT PLMT TARTCLR DV",
  "code_information": [
    {
      "code": "27279",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 56079.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35633.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31634.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31603.422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56079.354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29207.996875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27572.34905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD WRIST COMPLETE WO GRF",
  "code_information": [
    {
      "code": "25800",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD WRIST LMTD W/O B1 GRF",
  "code_information": [
    {
      "code": "25820",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD WRIST W/SLIDING GRAFT",
  "code_information": [
    {
      "code": "25805",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD WRIST WITH AUTOGRAFT",
  "code_information": [
    {
      "code": "25825",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRD WRST ILIAC/OTH AGRFT",
  "code_information": [
    {
      "code": "25810",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Arthro/shoul surg; w/spacer",
  "code_information": [
    {
      "code": "C9781",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS ELBW JOINT LOCAL",
  "code_information": [
    {
      "code": "24800",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS GLENOHUMERAL JT",
  "code_information": [
    {
      "code": "23800",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS HIP JOINT",
  "code_information": [
    {
      "code": "27284",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16512.69,
      "maximum": 16666.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS PANTALAR",
  "code_information": [
    {
      "code": "28705",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 56079.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35633.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31634.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31603.422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56079.354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27572.34905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29207.996875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS SUBTALAR",
  "code_information": [
    {
      "code": "28725",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS SYMPHYSIS PUBIS",
  "code_information": [
    {
      "code": "27282",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4208.34,
      "maximum": 4247.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRODESIS TRIPLE",
  "code_information": [
    {
      "code": "28715",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Arthroflex",
  "code_information": [
    {
      "code": "Q4125",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHROTOMY GLENHUMRL JT W/BX",
  "code_information": [
    {
      "code": "23100",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHROTOMY GLENOHUMERAL JT",
  "code_information": [
    {
      "code": "23105",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHROTOMY HIP W/DRAINAGE",
  "code_information": [
    {
      "code": "27030",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9332.7,
      "maximum": 9419.44,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHROTOMY STRNCLAV JOINT",
  "code_information": [
    {
      "code": "23106",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRP 1ST CRP/MTCRPL PROSTC",
  "code_information": [
    {
      "code": "1003T",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16512.69,
      "maximum": 16666.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRP NTRCRP/CRP/MTCR NTRPS",
  "code_information": [
    {
      "code": "25447",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRP NTRCRPL/CRP/MTCRP SSP",
  "code_information": [
    {
      "code": "25448",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRP PROSTC DSTL SCPH CRPL",
  "code_information": [
    {
      "code": "25443",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRP W/PROSTC DST RDS&CRPS",
  "code_information": [
    {
      "code": "25446",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 56079.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35633.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31634.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31603.422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56079.354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29207.996875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27572.34905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRP W/PROSTC DSTL RDS",
  "code_information": [
    {
      "code": "25441",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRP W/PROSTC DSTL ULNA",
  "code_information": [
    {
      "code": "25442",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 22551.42,
      "maximum": 56079.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 31634.86,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 35633.82,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 31603.422,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 56079.354,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22761.0075,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 27572.34905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 29207.996875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22551.4185,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 23366.3975,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRP W/PROSTC LUNATE",
  "code_information": [
    {
      "code": "25444",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRP W/PROSTC TRAPEZIUM",
  "code_information": [
    {
      "code": "25445",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS AID ACL RPR/AGMNTJ",
  "code_information": [
    {
      "code": "29888",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS AID PCL RPR/AGMNTJ",
  "code_information": [
    {
      "code": "29889",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 16348.58,
      "maximum": 39236.6,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22133.72,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 24931.64,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 22111.7155,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 39236.5956,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16666.1553,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 19291.32617,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 20435.726875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16512.6892,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 16348.5815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS AID RPR OD LES/TIB FX",
  "code_information": [
    {
      "code": "29892",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNE SRG ABRASJ ARTHRP",
  "code_information": [
    {
      "code": "29879",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNE SRG DRLG OST DISS",
  "code_information": [
    {
      "code": "29885",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNE SRG MNISC RPR M&L",
  "code_information": [
    {
      "code": "29883",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNE SRG MNISC RPR M/L",
  "code_information": [
    {
      "code": "29882",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNE SRG MNISECTMY M&L",
  "code_information": [
    {
      "code": "29880",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNE SRG MNISECTMY M/L",
  "code_information": [
    {
      "code": "29881",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE DX W/WO SYN BX",
  "code_information": [
    {
      "code": "29870",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE SRG DRLG OD FIXJ",
  "code_information": [
    {
      "code": "29887",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE SURG DBRDMT/SHVG",
  "code_information": [
    {
      "code": "29877",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE SURG DRLG OD LES",
  "code_information": [
    {
      "code": "29886",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE SURG FOR INFCTJ",
  "code_information": [
    {
      "code": "29871",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE SURG LYSIS ADS",
  "code_information": [
    {
      "code": "29884",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE SURG RMV LOOS/FB",
  "code_information": [
    {
      "code": "29874",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE SURG SYNVCT LMTD",
  "code_information": [
    {
      "code": "29875",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE SURG SYNVCT MAJ",
  "code_information": [
    {
      "code": "29876",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRS KNEE SURG W/LAT RLS",
  "code_information": [
    {
      "code": "29873",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT AC SC JT EXP/RMVL FB",
  "code_information": [
    {
      "code": "23044",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT ACRMCLV/STRNCLAV JT",
  "code_information": [
    {
      "code": "23101",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT ELBOW W/SYNOVECTOMY",
  "code_information": [
    {
      "code": "24102",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT ELBW CAPSL EXC RLS",
  "code_information": [
    {
      "code": "24006",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT ELBW EXPL DRG/RMVL FB",
  "code_information": [
    {
      "code": "24000",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT ELBW JT EXPL BX RMVL",
  "code_information": [
    {
      "code": "24101",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT ELBW SYNOVIAL BX ONLY",
  "code_information": [
    {
      "code": "24100",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT GH JT EXPL/DRG/RMV FB",
  "code_information": [
    {
      "code": "23040",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT GLENHUMRL JT W/EXPL",
  "code_information": [
    {
      "code": "23107",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT HIP EXPL/RMV LOOSE/FB",
  "code_information": [
    {
      "code": "27033",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 9076.82,
      "maximum": 21784.38,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 12288.76,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 13842.18,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12276.546,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 21784.37592,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9419.4406,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11346.029125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 10710.651494,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9332.7041,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9076.8233,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ARTHRT RDCRPL/MIDCARPL JT",
  "code_information": [
    {
      "code": "25040",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4122.6,
      "maximum": 9894.24,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5581.43,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 6286.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5575.8825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 9894.2436,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4247.4506,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5153.251875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4864.66977,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4208.339,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4122.6015,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Artificial Eye Lub 15-83% Oint",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "72570012235",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.69,
      "maximum": 22.33,
      "gross_charge": 22.33,
      "discounted_cash": 12.28,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.31161,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.9223,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.6893,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.631,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.33,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.6893,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.261716,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.181712,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.8155,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.86693,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 13.398,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.2135,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.2135,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.33,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.21835,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.33,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.398,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.2815,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.2815,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.932,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.73103,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.32424,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.02132,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.50288,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.780682,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 20.83389,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.142044,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 20.228747,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.33,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 19.775448,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ARTIFICIAL INSEMINATION",
  "code_information": [
    {
      "code": "58321",
      "type": "HCPCS"
    },
    {
      "code": "58322",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 255.61,
      "maximum": 927.61,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 523.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 589.42,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 389.81,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 346.06,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 522.7565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 345.7145,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 927.60912,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 613.45584,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.5759,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 262.4424,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.9333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.0258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 456.074484,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 483.12975,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 319.50825,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 301.615788,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.9333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.0258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 391.9333,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 260.0258,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 386.5038,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 255.6066,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Artificial larynx",
  "code_information": [
    {
      "code": "L8500",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 339.06,
      "maximum": 339.06,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 339.06,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Artificial saliva",
  "code_information": [
    {
      "code": "A9155",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 28.44,
      "maximum": 32.02,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 32.021152,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 28.4352,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Artificial Tears Drops",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "24385000605",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 4.79,
      "maximum": 22.83,
      "gross_charge": 22.83,
      "discounted_cash": 12.56,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.52011,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.0773,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.7943,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.981,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 22.83,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4.7943,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 8.364912,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 7.424316,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7.9905,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.17743,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 13.698,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.6885,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.6885,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.83,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.71585,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.83,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 13.698,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.5565,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 12.5565,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.132,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.92653,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.48824,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.22332,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 7.67088,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.268382,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.30039,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 21.615444,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 20.681697,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 22.83,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 20.218248,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Artiss fibrin sealant",
  "code_information": [
    {
      "code": "C9250",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 126.48,
      "maximum": 730.74,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 141.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 730.743572,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 141.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 134.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 134.5,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 126.483,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 141.89,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 340.536,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 487.1175,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 172.9375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 163.253,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 169.1677,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 142.47,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 138.35,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASAY OF INTERLEUKIN-6 (IL-6)",
  "code_information": [
    {
      "code": "83529",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 17.27,
      "maximum": 41.45,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 41.448,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 26.555581,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 24.8183,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.27,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 17.27,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ascendion per sq cm",
  "code_information": [
    {
      "code": "Q4390",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 160.06,
      "maximum": 161.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 161.5441,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 160.0565,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Ascent, 0.5 mg",
  "code_information": [
    {
      "code": "Q4213",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 156.76,
      "maximum": 156.76,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 156.755,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "Ascorbic Acid 500 MG Tablet",
  "drug_information": {
    "unit": 500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "10135014201",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 0.75,
      "maximum": 3.56,
      "gross_charge": 3.56,
      "discounted_cash": 1.96,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.48452,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.1036,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.7476,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.492,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 0.7476,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.304384,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1.157712,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.246,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 2.21076,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 2.136,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.382,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3.382,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.5422,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2.136,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1.958,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.424,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.39196,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.16768,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.43824,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1.19616,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.472424,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.32148,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.370608,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.225004,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.56,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 3.152736,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Ascorbic Acid 500 MG/Ml Vial",
  "drug_information": {
    "unit": 500.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "67457011850",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 177.03,
      "maximum": 843.0,
      "gross_charge": 843.0,
      "discounted_cash": 463.65,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 351.531,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 261.33,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 177.03,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 590.1,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 843.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 177.03,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 308.8752,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 274.1436,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 295.05,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 523.503,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 505.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 800.85,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 800.85,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 843.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 838.785,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 843.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 505.8,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 463.65,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 463.65,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 337.2,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 329.613,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 276.504,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 340.572,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 283.248,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 822.2622,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 786.519,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 798.1524,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 763.6737,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 843.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 746.5608,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "Ascvd rsk mng clin stf pr mo",
  "code_information": [
    {
      "code": "G0538",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 117.53,
      "maximum": 282.07,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 159.13,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 179.24,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 158.973,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 282.0732,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 131.8756,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 146.913125,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 138.68599,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 130.6612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 117.5305,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASHKENAZI JEWISH ASSOC DIS",
  "code_information": [
    {
      "code": "81412",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2448.56,
      "maximum": 5876.54,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2448.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2448.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2448.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5876.544,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3763.561932,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 3517.3476,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2448.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2448.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2448.56,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2448.56,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Asmanex Twisthalr 220 Mcg #120",
  "drug_information": {
    "unit": 1.0,
    "type": "EA"
  },
  "code_information": [
    {
      "code": "78206011401",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 237.09,
      "maximum": 1129.0,
      "gross_charge": 1129.0,
      "discounted_cash": 620.95,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 470.793,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 349.99,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 237.09,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 790.3,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1129.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 237.09,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 413.6656,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 367.1508,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 395.15,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 701.109,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 677.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1072.55,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 1072.55,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1129.0,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1123.355,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1129.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 677.4,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 620.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 620.95,
          "standard_charge_percentage": 55.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 451.6,
          "standard_charge_percentage": 40.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 370.312,
          "standard_charge_percentage": 32.8,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Care",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 441.439,
          "standard_charge_percentage": 39.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 456.116,
          "standard_charge_percentage": 40.4,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UC Ship",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 379.344,
          "standard_charge_percentage": 33.6,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1101.2266,
          "standard_charge_percentage": 97.54,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1053.357,
          "standard_charge_percentage": 93.3,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 1068.9372,
          "standard_charge_percentage": 94.68,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC National",
          "plan_name": "NATIONAL",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1022.7611,
          "standard_charge_percentage": 90.59,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1129.0,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "UHC Select_Select Plus",
          "plan_name": "SELECT_SELECT PLUS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 999.8424,
          "standard_charge_percentage": 88.56,
          "count": "0",
          "methodology": "percent of total billed charges"
        }
      ],
      "additional_generic_notes": "0 remits to support allowed amounts"
    }
  ]
},
{
  "description": "ASPA GENE",
  "code_information": [
    {
      "code": "81200",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 47.25,
      "maximum": 113.4,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 113.4,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 72.619937,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 67.8691,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.25,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 47.25,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Asparaginase, nos",
  "code_information": [
    {
      "code": "J9020",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 69.02,
      "maximum": 258.26,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 258.257552,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 69.02,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "Per Service Unit Rate"
    }
  ]
},
{
  "description": "ASPERGILLUS AG IA",
  "code_information": [
    {
      "code": "87305",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 8.66,
      "maximum": 28.75,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 28.752,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 18.421013,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 17.2159,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 8.66,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 11.98,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASPERGILLUS ANTIBODY",
  "code_information": [
    {
      "code": "86606",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 13.38,
      "maximum": 36.12,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 36.12,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 23.126766,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 21.6138,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medi-Cal",
          "plan_name": "MEDI-CAL",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 13.38,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.05,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 15.05,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASPIR/INJ THYROID CYST",
  "code_information": [
    {
      "code": "60300",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 893.98,
      "maximum": 2145.56,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 893.9815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 893.9815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1210.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1363.32,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1209.122,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 893.9815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2145.5556,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 919.241,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 910.7764,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1117.476875,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1054.89817,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 893.9815,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 910.7764,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 910.7764,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 893.9815,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASPIRATE PLEURA W/ IMAGING",
  "code_information": [
    {
      "code": "32555",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 785.56,
      "maximum": 1885.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1063.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1197.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1062.4895,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1885.34688,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 814.3148,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 806.8164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 926.962216,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 981.9515,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 806.8164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 806.8164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASPIRATE PLEURA W/O IMAGING",
  "code_information": [
    {
      "code": "32554",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 785.56,
      "maximum": 1885.35,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1197.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 1063.54,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1062.4895,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 1885.34688,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 814.3148,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 806.8164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 981.9515,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 926.962216,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 806.8164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 806.8164,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 785.5612,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASPIRATE/INJ GANGLION CYST",
  "code_information": [
    {
      "code": "20612",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 375.07,
      "maximum": 900.16,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 375.0684,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 375.0684,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 507.8,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 571.99,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 507.2905,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 375.0684,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 900.16416,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 398.4602,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 394.791,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 468.8355,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 442.580712,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 375.0684,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 394.791,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 394.791,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 375.0684,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "ASPIRATION ORBITAL CONTENTS",
  "code_information": [
    {
      "code": "67415",
      "type": "HCPCS"
    }
  ],
  "standard_charges": [
    {
      "minimum": 2964.26,
      "maximum": 7114.22,
      "setting": "outpatient",
      "payers_information": [
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2964.259,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2964.259,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4520.49,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 4013.19,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 4009.1995,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2964.259,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 7114.2216,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3086.262,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "HealthCare Partners HMO",
          "plan_name": "HMO-Medicare",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3057.8429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "PASC",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3497.82562,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Commercial",
          "plan_name": "Covered CA",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3705.32375,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "LA Care Medicare_DSNP",
          "plan_name": "MEDICARE ADVANTAGE_DSNP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2964.259,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "TriWest Healthcare Alliance",
          "plan_name": "Other Government",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3057.8429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UCLA Health Medicare Advantage Plan",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3057.8429,
          "count": "0",
          "methodology": "fee schedule"
        },
        {
          "payer_name": "UHC Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 2964.259,
          "count": "0",
          "methodology": "fee schedule"
        }
      ],
      "additional_generic_notes": "No additional generic notes"
    }
  ]
},
{
  "description": "Aspirin 300 MG Suppository",
  "drug_information": {
    "unit": 300.0,
    "type": "ME"
  },
  "code_information": [
    {
      "code": "00574703412",
      "type": "NDC"
    }
  ],
  "standard_charges": [
    {
      "minimum": 3.3,
      "maximum": 15.7,
      "gross_charge": 15.7,
      "discounted_cash": 8.64,
      "setting": "inpatient",
      "payers_information": [
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 6.5469,
          "standard_charge_percentage": 41.7,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 4.867,
          "standard_charge_percentage": 31.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Aetna Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.297,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Blue Cross",
          "plan_name": "ALL PRODUCTS",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 10.99,
          "standard_charge_percentage": 70.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Indemnity",
          "plan_name": "INDEMNITY",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 15.7,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Medicare Advantage",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 3.297,
          "standard_charge_percentage": 21.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-City of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.10564,
          "standard_charge_percentage": 32.52,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Vivity, Anthem HMO",
          "plan_name": "HMO-NonCity of LA",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 5.75248,
          "standard_charge_percentage": 36.64,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Anthem Workers Comp",
          "plan_name": "WORKERS COMP",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 9.7497,
          "standard_charge_percentage": 62.1,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "IFP-EPN",
          "additional_payer_notes": "Can be subject to lesser of provisions , Percent rate is limited by maximum value, but this maximum can be exceeded by other provisions",
          "standard_charge_dollar": 9.42,
          "standard_charge_percentage": 60.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "Medicare Advantage",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_dollar": 5.495,
          "standard_charge_percentage": 35.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Blue Shield of California",
          "plan_name": "All Products",
          "additional_payer_notes": "Can be subject to lesser of provisions , In these circumstances, the service may be packaged/bundled into a separate rate or priced through a separate carrier where the rate was not available.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Centivo",
          "plan_name": "PPO",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For example, items with a negotiated rate of 0 or blank.",
          "standard_charge_algorithm": "Bundled into Service Package",
          "count": "0",
          "methodology": "other"
        },
        {
          "payer_name": "Cigna HMO",
          "plan_name": "HMO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.915,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Cigna PPO",
          "plan_name": "PPO",
          "additional_payer_notes": "No payer specific notes",
          "standard_charge_dollar": 14.915,
          "standard_charge_percentage": 95.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to stoploss provisions, Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.7,
          "standard_charge_percentage": 100.0,
          "standard_charge_algorithm": "Can be subject to stoploss provisions",
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.6215,
          "standard_charge_percentage": 99.5,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Commercial Non B&G",
          "plan_name": "All PRODUCTS",
          "additional_payer_notes": "Can be subject to lesser of provisions",
          "standard_charge_dollar": 15.7,
          "standard_charge_percentage": 100.0,
          "count": "0",
          "methodology": "percent of total billed charges"
        },
        {
          "payer_name": "Health Net Medicare",
          "plan_name": "MEDICARE ADVANTAGE",
          "additional_payer_notes": "Line item charges and subsequent payments can be subject to service bundling. For exam